Provider Demographics
NPI:1356816664
Name:FAZZINI, EVA (DPT, PT)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:FAZZINI
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:
Other - Last Name:BOWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7257 CAMDEN PINE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-4407
Mailing Address - Country:US
Mailing Address - Phone:206-940-5819
Mailing Address - Fax:
Practice Address - Street 1:1550 W CRAIG RD STE 210
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-0224
Practice Address - Country:US
Practice Address - Phone:702-360-9142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty