Provider Demographics
NPI:1649742941
Name:PENARANDA, JULIAN (DPT)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:
Last Name:PENARANDA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6167 ALLEN COVE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1799
Mailing Address - Country:US
Mailing Address - Phone:847-445-8126
Mailing Address - Fax:
Practice Address - Street 1:105 N PECOS RD STE 130
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-1995
Practice Address - Country:US
Practice Address - Phone:702-685-1607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3834225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty