Provider Demographics
NPI:1629186945
Name:SPARROW, NIC
Entity Type:Individual
Prefix:
First Name:NIC
Middle Name:
Last Name:SPARROW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 S RAINBOW BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0029
Mailing Address - Country:US
Mailing Address - Phone:702-916-2777
Mailing Address - Fax:702-916-2778
Practice Address - Street 1:5785 CENTENNIAL CENTER BLVD STE 220
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-7111
Practice Address - Country:US
Practice Address - Phone:702-916-2777
Practice Address - Fax:702-916-2778
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1257OtherLICENSE #
NV104361Medicare PIN