Provider Demographics
NPI:1437109188
Name:HIGH DESERT THERAPISTS, INC.
Entity Type:Organization
Organization Name:HIGH DESERT THERAPISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LENDELL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:775-883-4161
Mailing Address - Street 1:2874 N CARSON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-0177
Mailing Address - Country:US
Mailing Address - Phone:775-883-4161
Mailing Address - Fax:
Practice Address - Street 1:1701 COUNTY RD
Practice Address - Street 2:#B
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4464
Practice Address - Country:US
Practice Address - Phone:775-782-4466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV34391Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER