Provider Demographics
NPI:1053850610
Name:WOYTUS, IAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:WOYTUS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 W. HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:702-893-3333
Mailing Address - Fax:702-893-0960
Practice Address - Street 1:2821 W. HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE # 101
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-893-3333
Practice Address - Fax:702-893-0960
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27229225100000X
NC17876225100000X
TN11544225100000X
VA2305212001225100000X
WA60697660225100000X
TX1281955225100000X
NV4053225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8967218OtherMEDICARE
VA1053850610Medicaid