Provider Demographics
NPI:1932397304
Name:CORE PHYSICAL THERAPY
Entity type:Organization
Organization Name:CORE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GERVASI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-990-4123
Mailing Address - Street 1:68 N PECOS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7339
Mailing Address - Country:US
Mailing Address - Phone:702-990-4123
Mailing Address - Fax:
Practice Address - Street 1:68 N PECOS RD
Practice Address - Street 2:SUITE B
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7339
Practice Address - Country:US
Practice Address - Phone:702-990-4123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV100957Medicare PIN