Provider Demographics
NPI:1841567344
Name:SPEVAK PHYSICAL THERAPY NEVADA LLC
Entity Type:Organization
Organization Name:SPEVAK PHYSICAL THERAPY NEVADA LLC
Other - Org Name:ACTIVE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPEVAK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, OCS
Authorized Official - Phone:775-786-2400
Mailing Address - Street 1:3594 W PLUMB LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3696
Mailing Address - Country:US
Mailing Address - Phone:775-786-2400
Mailing Address - Fax:
Practice Address - Street 1:3594 W PLUMB LN
Practice Address - Street 2:SUITE B
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3696
Practice Address - Country:US
Practice Address - Phone:775-786-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty