Provider Demographics
NPI:1184688616
Name:TOLBOE, RICHARD B (MS, PT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:B
Last Name:TOLBOE
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:129 W LAKE MEAD PKWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7055
Mailing Address - Country:US
Mailing Address - Phone:702-564-6712
Mailing Address - Fax:702-564-4838
Practice Address - Street 1:129 W LAKE MEAD PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7055
Practice Address - Country:US
Practice Address - Phone:702-564-6712
Practice Address - Fax:702-564-4838
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVS01815Medicare UPIN
NVWQBHGMedicare ID - Type Unspecified