Provider Demographics
NPI:1508475203
Name:POWERHOUSE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:POWERHOUSE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:RESASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-388-7082
Mailing Address - Street 1:3050 E BONANZA RD STE 110D
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-3706
Mailing Address - Country:US
Mailing Address - Phone:201-388-7082
Mailing Address - Fax:
Practice Address - Street 1:3050 E BONANZA RD STE 110D
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-3706
Practice Address - Country:US
Practice Address - Phone:201-388-7082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty