| NPI | 1720480510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON SNEAD Manager 702-518-5774 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| 2081P0004X Physical Medicine & Rehabilitation Spinal Cord Injury Medicine | |
| 2255A2300X Specialist/Technologist Athletic Trainer | |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant Medical | |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2023-11-01 |