Provider Demographics
NPI:1073099222
Name:AGBAYANI, REX
Entity Type:Individual
Prefix:
First Name:REX
Middle Name:
Last Name:AGBAYANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 W WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-3586
Mailing Address - Country:US
Mailing Address - Phone:702-547-2041
Mailing Address - Fax:
Practice Address - Street 1:1500 W WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-3586
Practice Address - Country:US
Practice Address - Phone:702-547-2041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist