Provider Demographics
NPI:1457911364
Name:BASIC HEALING LLC
Entity Type:Organization
Organization Name:BASIC HEALING LLC
Other - Org Name:BASIC HEALING PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLISSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-517-7982
Mailing Address - Street 1:1466 VERDE TRIANDOS DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4427
Mailing Address - Country:US
Mailing Address - Phone:845-517-7982
Mailing Address - Fax:702-778-5800
Practice Address - Street 1:1466 VERDE TRIANDOS DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-4427
Practice Address - Country:US
Practice Address - Phone:845-517-7982
Practice Address - Fax:702-778-5800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1659727964Medicaid