Provider Demographics
NPI:1891070934
Name:THI OF NEVADA AT DESERT VALLEY THERAPY LLC
Entity Type:Organization
Organization Name:THI OF NEVADA AT DESERT VALLEY THERAPY LLC
Other - Org Name:DESERT VALLEY THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-998-3333
Mailing Address - Street 1:920 RIDGEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9390
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1701 N GREEN VALLEY PKWY
Practice Address - Street 2:BLDG 8 SUITE B
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5885
Practice Address - Country:US
Practice Address - Phone:702-998-3333
Practice Address - Fax:702-260-4051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty