Provider Demographics
NPI:1205838265
Name:MARCHANT PHYSICAL THERAPY & WELLNESS, INC.
Entity Type:Organization
Organization Name:MARCHANT PHYSICAL THERAPY & WELLNESS, INC.
Other - Org Name:FIT PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:ISMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:209-353-1988
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89024-0069
Mailing Address - Country:US
Mailing Address - Phone:702-346-3105
Mailing Address - Fax:703-346-3544
Practice Address - Street 1:340 FALCON RIDGE PARKWAY
Practice Address - Street 2:BUILDING 500
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027
Practice Address - Country:US
Practice Address - Phone:702-346-3105
Practice Address - Fax:702-346-3544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-02
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV78602174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506216Medicaid
NVV35485Medicare PIN