Provider Demographics
NPI:1558785246
Name:ELIAS, MAYSSA (PTA)
Entity Type:Individual
Prefix:
First Name:MAYSSA
Middle Name:
Last Name:ELIAS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10550 PARK RUN DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-4575
Mailing Address - Country:US
Mailing Address - Phone:702-515-6200
Mailing Address - Fax:
Practice Address - Street 1:10550 PARK RUN DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-4575
Practice Address - Country:US
Practice Address - Phone:702-515-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-14
Last Update Date:2015-01-21
Deactivation Date:2014-12-04
Deactivation Code:
Reactivation Date:2015-01-21
Provider Licenses
StateLicense IDTaxonomies
NVA-0697225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant