Provider Demographics
NPI:1023558426
Name:ADVANCED MANUAL THERAPY INSTITUTE I LLC
Entity Type:Organization
Organization Name:ADVANCED MANUAL THERAPY INSTITUTE I LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RANTISSI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, MOT, MTC
Authorized Official - Phone:702-896-0383
Mailing Address - Street 1:2625 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE 120
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 1:6424 LOSEE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-0101
Practice Address - Country:US
Practice Address - Phone:702-896-0383
Practice Address - Fax:702-889-0383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1735225100000X
NV1719225100000X
NV0662225X00000X
NV0663225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPTANOtherV101390
NVV101389OtherPTAN
NVV101391OtherPTAN
NVV101393OtherPTAN
NVV101392OtherPTAN
NVV101391OtherPTAN