Provider Demographics
NPI:1871251116
Name:FLORIDO, KAMILLE NIKOLE HUEYSUWAN (PT, DPT, PTRP, RBT)
Entity Type:Individual
Prefix:
First Name:KAMILLE NIKOLE
Middle Name:HUEYSUWAN
Last Name:FLORIDO
Suffix:
Gender:F
Credentials:PT, DPT, PTRP, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 E MESA VERDE LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-1812
Mailing Address - Country:US
Mailing Address - Phone:702-227-4477
Mailing Address - Fax:
Practice Address - Street 1:3199 E WARM SPRINGS RD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3150
Practice Address - Country:US
Practice Address - Phone:702-992-1793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4876225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist