Provider Demographics
NPI:1427259704
Name:LAS VEGAS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:LAS VEGAS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:MASEO
Authorized Official - Last Name:NAKASONE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:505-425-7762
Mailing Address - Street 1:508 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4349
Mailing Address - Country:US
Mailing Address - Phone:505-425-7762
Mailing Address - Fax:505-454-9880
Practice Address - Street 1:508 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4349
Practice Address - Country:US
Practice Address - Phone:505-425-7762
Practice Address - Fax:505-454-9880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty