Provider Demographics
NPI:1699310938
Name:CHAHARLANG, NICK (DPT)
Entity type:Individual
Prefix:
First Name:NICK
Middle Name:
Last Name:CHAHARLANG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 W HORIZON RIDGE PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2896
Mailing Address - Country:US
Mailing Address - Phone:702-896-0383
Mailing Address - Fax:702-889-0383
Practice Address - Street 1:8988 W CHEYENNE AVE STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-8928
Practice Address - Country:US
Practice Address - Phone:702-896-0383
Practice Address - Fax:702-889-0383
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist