Provider Demographics
NPI:1437778784
Name:LVC PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:LVC PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING CONTACT
Authorized Official - Prefix:MS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OWYONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-235-5778
Mailing Address - Street 1:3145 SAINT ROSE PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3559
Mailing Address - Country:US
Mailing Address - Phone:702-235-5778
Mailing Address - Fax:
Practice Address - Street 1:1050 S RAINBOW BLVD STE 210
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-6231
Practice Address - Country:US
Practice Address - Phone:702-235-5778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV20201715707OtherBUSINESS LICENSE