Provider Demographics
NPI:1659727964
Name:BASIC HEALING LLC
Entity Type:Organization
Organization Name:BASIC HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLISSER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-517-7910
Mailing Address - Street 1:1699 YUCATAN CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-3607
Mailing Address - Country:US
Mailing Address - Phone:845-517-7910
Mailing Address - Fax:
Practice Address - Street 1:9005 S PECOS RD STE 2600
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7192
Practice Address - Country:US
Practice Address - Phone:845-517-7910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3031225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty