Provider Demographics
NPI:1972526192
Name:INDRIERI, JOSEPH (DPT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:INDRIERI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8951 W SAHARA AVE
Mailing Address - Street 2:SUITE 190
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5898
Mailing Address - Country:US
Mailing Address - Phone:702-685-1607
Mailing Address - Fax:702-685-1506
Practice Address - Street 1:8951 W SAHARA AVE
Practice Address - Street 2:SUITE 190
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5898
Practice Address - Country:US
Practice Address - Phone:702-685-1607
Practice Address - Fax:702-685-1506
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1008623008OtherSTATE LICENSE
NV1386871630Medicaid
CU532AMedicare UPIN