Provider Demographics
NPI:1417798281
Name:BROBERG PHYSICAL THERAPY LV LLC
Entity type:Organization
Organization Name:BROBERG PHYSICAL THERAPY LV LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:408-202-2011
Mailing Address - Street 1:10080 W TROPICANA AVE STE 164
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8464
Mailing Address - Country:US
Mailing Address - Phone:408-202-2011
Mailing Address - Fax:
Practice Address - Street 1:10080 W TROPICANA AVE STE 164
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8464
Practice Address - Country:US
Practice Address - Phone:408-202-2011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty