Provider Demographics
NPI:1376175786
Name:MAXICARE THERAPY AND WELLNESS OF NEVADA
Entity Type:Organization
Organization Name:MAXICARE THERAPY AND WELLNESS OF NEVADA
Other - Org Name:MAXICARE THERAPY AND WELLNESS OF NEVADA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:GORGONIA
Authorized Official - Last Name:TIU
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPT
Authorized Official - Phone:702-381-6053
Mailing Address - Street 1:4510 S EASTERN AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6118
Mailing Address - Country:US
Mailing Address - Phone:702-381-6053
Mailing Address - Fax:702-987-0199
Practice Address - Street 1:4510 S EASTERN AVE STE 5
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6118
Practice Address - Country:US
Practice Address - Phone:702-381-6053
Practice Address - Fax:702-987-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-04
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonaryGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Multi-Specialty
No2278P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary RehabilitationGroup - Multi-Specialty