Provider Demographics
NPI:1821513086
Name:HEVRIN, BRENTON (PTA)
Entity Type:Individual
Prefix:
First Name:BRENTON
Middle Name:
Last Name:HEVRIN
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 1:70 E HORIZON RIDGE PKWY STE 180
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-7937
Mailing Address - Country:US
Mailing Address - Phone:702-856-0422
Mailing Address - Fax:702-433-0425
Practice Address - Street 1:70 E HORIZON RIDGE PKWY STE 180
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002-7937
Practice Address - Country:US
Practice Address - Phone:702-856-0422
Practice Address - Fax:702-433-0425
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-1035225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant