Provider Demographics
NPI:1528107174
Name:AMICK, GARY C (PT)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:C
Last Name:AMICK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3399 S EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3312
Mailing Address - Country:US
Mailing Address - Phone:702-733-1842
Mailing Address - Fax:702-732-4454
Practice Address - Street 1:3399 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3312
Practice Address - Country:US
Practice Address - Phone:702-733-1842
Practice Address - Fax:702-732-4454
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV0223225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist