Provider Demographics
NPI:1427543081
Name:PHYSIOSPINE RENO, LLC
Entity Type:Organization
Organization Name:PHYSIOSPINE RENO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WESSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:775-399-4094
Mailing Address - Street 1:6880 S MCCARRAN BLVD STE 13
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6129
Mailing Address - Country:US
Mailing Address - Phone:775-399-4094
Mailing Address - Fax:775-201-6613
Practice Address - Street 1:6880 S MCCARRAN BLVD STE 13
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6129
Practice Address - Country:US
Practice Address - Phone:775-399-4094
Practice Address - Fax:775-201-6613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV37022251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty