Provider Demographics
NPI:1457544611
Name:ALWARDT, TINA LYNN (PT)
Entity Type:Individual
Prefix:MISS
First Name:TINA
Middle Name:LYNN
Last Name:ALWARDT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7361 PRAIRIE FALCON RD
Mailing Address - Street 2:130-B
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0823
Mailing Address - Country:US
Mailing Address - Phone:702-243-0515
Mailing Address - Fax:702-243-2019
Practice Address - Street 1:7361 PRAIRIE FALCON RD
Practice Address - Street 2:130-B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0823
Practice Address - Country:US
Practice Address - Phone:702-243-0515
Practice Address - Fax:702-243-2019
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1864225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100505757Medicaid
NV100505757Medicaid
NVV104546Medicare PIN
NVEV676YMedicare PIN