Provider Demographics
NPI:1457477754
Name:WANG, CALVIN L (MPT)
Entity Type:Individual
Prefix:MR
First Name:CALVIN
Middle Name:L
Last Name:WANG
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 MEDICAL CENTER ST
Mailing Address - Street 2:#100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2404
Mailing Address - Country:US
Mailing Address - Phone:702-222-1000
Mailing Address - Fax:702-222-9448
Practice Address - Street 1:2779 W. HORIZON RIDGE PKWY
Practice Address - Street 2:#100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89148-2404
Practice Address - Country:US
Practice Address - Phone:702-897-1222
Practice Address - Fax:702-897-1252
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV36635Medicare PIN
NVV36635Medicare Oscar/Certification