Provider Demographics
NPI:1134281165
Name:ATHLETES' PERFORMANCE LAS VEGAS LLC
Entity Type:Organization
Organization Name:ATHLETES' PERFORMANCE LAS VEGAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-626-4589
Mailing Address - Street 1:2730 S RANCHO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-6400
Mailing Address - Country:US
Mailing Address - Phone:702-257-8911
Mailing Address - Fax:702-257-9411
Practice Address - Street 1:2730 S RANCHO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-6400
Practice Address - Country:US
Practice Address - Phone:702-257-8911
Practice Address - Fax:702-257-9411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty