Provider Demographics
NPI:1346622719
Name:BEYOND BOUNDARIES
Entity Type:Organization
Organization Name:BEYOND BOUNDARIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:978-302-9529
Mailing Address - Street 1:5550 PAINTED MIRAGE RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4581
Mailing Address - Country:US
Mailing Address - Phone:702-444-0774
Mailing Address - Fax:702-834-3256
Practice Address - Street 1:5550 PAINTED MIRAGE RD
Practice Address - Street 2:SUITE 320
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4581
Practice Address - Country:US
Practice Address - Phone:702-444-0774
Practice Address - Fax:702-834-3256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPT2971225100000X
NV14-0449225X00000X
NV14-0530225XN1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV111142Medicare PIN