Provider Demographics
NPI:1407924178
Name:PHYSICAL THERAPY PARTNERS NEVADA LLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY PARTNERS NEVADA LLC
Other - Org Name:SOAR PHYSICAL THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOYD
Authorized Official - Middle Name:A
Authorized Official - Last Name:ETTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DIP MDT, OCS
Authorized Official - Phone:775-853-7475
Mailing Address - Street 1:415 US HIGHWAY 95A S
Mailing Address - Street 2:C302
Mailing Address - City:FERNLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89408-9261
Mailing Address - Country:US
Mailing Address - Phone:775-575-1818
Mailing Address - Fax:775-515-1808
Practice Address - Street 1:10775 DOUBLE R BLVD
Practice Address - Street 2:100
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-8956
Practice Address - Country:US
Practice Address - Phone:775-853-7475
Practice Address - Fax:775-853-2013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100505650Medicaid
NVV104480OtherMEDICARE PTAN