Provider Demographics
NPI:1649237876
Name:PREMIER PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PREMIER PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:PATTEN
Authorized Official - Last Name:GROW
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:775-777-0901
Mailing Address - Street 1:2213 NORTH 5TH STEET
Mailing Address - Street 2:SUITE B
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-2471
Mailing Address - Country:US
Mailing Address - Phone:775-777-0901
Mailing Address - Fax:775-777-0923
Practice Address - Street 1:2213 NORTH 5TH STEET
Practice Address - Street 2:SUITE B
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-2471
Practice Address - Country:US
Practice Address - Phone:775-777-0901
Practice Address - Fax:775-777-0923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1463261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100151Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
NV100152Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #