Provider Demographics
NPI:1265661185
Name:GILES, JOHN DOUGLAS (DPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DOUGLAS
Last Name:GILES
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 1:340 FALCON RIDGE PKWY
Mailing Address - Street 2:#500
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89027-8850
Mailing Address - Country:US
Mailing Address - Phone:702-346-3105
Mailing Address - Fax:702-346-3544
Practice Address - Street 1:475 N. MOAPA VALLEY BLVD.
Practice Address - Street 2:
Practice Address - City:OVERTON
Practice Address - State:NV
Practice Address - Zip Code:89040-9012
Practice Address - Country:US
Practice Address - Phone:702-397-6700
Practice Address - Fax:702-397-6707
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCS292ZMedicare PIN