Provider Demographics
NPI:1457534869
Name:EDWIN SUAREZ PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:EDWIN SUAREZ PHYSICAL THERAPY, LLC
Other - Org Name:SAUREZ PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ENEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-522-7756
Mailing Address - Street 1:3620 E SUNSET RD
Mailing Address - Street 2:#100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-7233
Mailing Address - Country:US
Mailing Address - Phone:702-368-6778
Mailing Address - Fax:702-368-6775
Practice Address - Street 1:3620 E SUNSET RD
Practice Address - Street 2:#100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-7233
Practice Address - Country:US
Practice Address - Phone:702-368-6778
Practice Address - Fax:702-368-6775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506866Medicaid
NVV38502Medicare PIN