Provider Demographics
NPI:1568065795
Name:UNAITE, IAKOPO NICK (PTA)
Entity Type:Individual
Prefix:
First Name:IAKOPO
Middle Name:NICK
Last Name:UNAITE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9077 CABRERA COVE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-3226
Mailing Address - Country:US
Mailing Address - Phone:702-469-0683
Mailing Address - Fax:
Practice Address - Street 1:4501 N BLAGG RD
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89060-1931
Practice Address - Country:US
Practice Address - Phone:775-751-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-1292225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant