Provider Demographics
NPI:1164678256
Name:THURNER, MICHAEL SAMUEL (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SAMUEL
Last Name:THURNER
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 1:5920 S. RAINBOW BLVD SUITE 1
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118
Mailing Address - Country:US
Mailing Address - Phone:702-248-7903
Mailing Address - Fax:702-248-7906
Practice Address - Street 1:5920 S. RAINBOW BLVD. SUITE 1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118
Practice Address - Country:US
Practice Address - Phone:702-248-7903
Practice Address - Fax:702-248-7906
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1164678256Medicaid
NVV36885Medicare PIN
NVBH704YMedicare PIN