Provider Demographics
NPI:1255928693
Name:SOUTHERN HILLS PELVIC AND PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:SOUTHERN HILLS PELVIC AND PHYSICAL THERAPY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHOSHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:IZKHAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-388-8716
Mailing Address - Street 1:9414 DEL WEBB BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-8314
Mailing Address - Country:US
Mailing Address - Phone:702-331-1654
Mailing Address - Fax:
Practice Address - Street 1:5775 S FORT APACHE RD STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5627
Practice Address - Country:US
Practice Address - Phone:702-331-1654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty