Provider Demographics
NPI:1295365062
Name:SILVER STATE PHYSICAL THERAPY AND WELLNESS LLC
Entity Type:Organization
Organization Name:SILVER STATE PHYSICAL THERAPY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SOUKUP
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:775-233-5281
Mailing Address - Street 1:203 THORNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NV
Mailing Address - Zip Code:89403-8608
Mailing Address - Country:US
Mailing Address - Phone:775-233-5281
Mailing Address - Fax:
Practice Address - Street 1:203 THORNWOOD CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NV
Practice Address - Zip Code:89403-8608
Practice Address - Country:US
Practice Address - Phone:775-233-5281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy