Provider Demographics
NPI:1427502715
Name:LAS VEGAS PHYSICAL THERAPY & SPORTS PLLC
Entity type:Organization
Organization Name:LAS VEGAS PHYSICAL THERAPY & SPORTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DONATELLI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:702-586-2358
Mailing Address - Street 1:7229 W SAHARA AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2851
Mailing Address - Country:US
Mailing Address - Phone:702-586-2177
Mailing Address - Fax:702-586-2358
Practice Address - Street 1:7229 W SAHARA AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2851
Practice Address - Country:US
Practice Address - Phone:702-586-2177
Practice Address - Fax:702-586-2358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1005070392Medicaid
NVV101780Medicare PIN
NVV36885Medicare PIN