Provider Demographics
NPI:1316562085
Name:PACUK, TREVOR JOHN (DPT)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:JOHN
Last Name:PACUK
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:PO BOX 50509
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89016-0509
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?:Yes
Enumeration Date:2020-06-09
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4286225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist