Provider Demographics
NPI:1952457038
Name:ORTHOSPORT PHYSICAL THERAPY AND SPORTS PERFORMANCE, INC
Entity Type:Organization
Organization Name:ORTHOSPORT PHYSICAL THERAPY AND SPORTS PERFORMANCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-892-9077
Mailing Address - Street 1:2800 E DESERT INN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3608
Mailing Address - Country:US
Mailing Address - Phone:702-892-9077
Mailing Address - Fax:702-892-9044
Practice Address - Street 1:2800 E DESERT INN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3608
Practice Address - Country:US
Practice Address - Phone:702-892-9077
Practice Address - Fax:702-892-9044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2000002-3222251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV36345Medicare ID - Type Unspecified