Provider Demographics
NPI:1861002024
Name:MOTAKEF, AVA (DPT)
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:
Last Name:MOTAKEF
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 W FLAMINGO RD UNIT 2179
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-4230
Mailing Address - Country:US
Mailing Address - Phone:678-551-0444
Mailing Address - Fax:
Practice Address - Street 1:3820 S JONES BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2228
Practice Address - Country:US
Practice Address - Phone:702-818-5000
Practice Address - Fax:702-818-5001
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014604225100000X
NV4374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist