Provider Demographics
NPI:1356987804
Name:DESOASIDO, JOY
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:DESOASIDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5155 S DURANGO DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-0174
Mailing Address - Country:US
Mailing Address - Phone:702-869-4401
Mailing Address - Fax:702-869-9904
Practice Address - Street 1:5155 S DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-0173
Practice Address - Country:US
Practice Address - Phone:702-869-4401
Practice Address - Fax:702-869-9904
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60633919225100000X
NV4333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist