Provider Demographics
NPI:1215536891
Name:BARADI, MAVERICK (DPT)
Entity Type:Individual
Prefix:
First Name:MAVERICK
Middle Name:
Last Name:BARADI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 W HORIZON RIDGE PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5062
Mailing Address - Country:US
Mailing Address - Phone:702-294-7498
Mailing Address - Fax:702-294-7495
Practice Address - Street 1:2930 W HORIZON RIDGE PKWY STE 205
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5062
Practice Address - Country:US
Practice Address - Phone:702-294-7498
Practice Address - Fax:702-294-7495
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty