Provider Demographics
NPI:1225133903
Name:IWAKAWA, TONY K (DPT)
Entity Type:Individual
Prefix:MR
First Name:TONY
Middle Name:K
Last Name:IWAKAWA
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
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:702-597-8999
Mailing Address - Fax:702-597-8988
Practice Address - Street 1:2930 W. HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-597-8999
Practice Address - Fax:702-597-8988
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100508311Medicaid
NV100508311Medicaid
NVV36885Medicare PIN