Provider Demographics
NPI:1215595038
Name:MORESCA, MAC NEIL (DPT)
Entity Type:Individual
Prefix:
First Name:MAC NEIL
Middle Name:
Last Name:MORESCA
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 1:7688 BLUE DIAMOND ROAD
Mailing Address - Street 2:APT. 3129
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178
Mailing Address - Country:US
Mailing Address - Phone:808-237-0120
Mailing Address - Fax:
Practice Address - Street 1:1550 WEST CRAIG ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032
Practice Address - Country:US
Practice Address - Phone:702-360-9142
Practice Address - Fax:702-649-0147
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist