Provider Demographics
NPI:1669552873
Name:ANTHEM PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:ANTHEM PHYSICAL THERAPY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:702-614-0324
Mailing Address - Street 1:1710 W HORIZON RIDGE PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4901
Mailing Address - Country:US
Mailing Address - Phone:702-489-9217
Mailing Address - Fax:702-489-9134
Practice Address - Street 1:11201 S EASTERN AVE
Practice Address - Street 2:STE 220
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-6201
Practice Address - Country:US
Practice Address - Phone:702-614-0324
Practice Address - Fax:702-341-0324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2022-10-24
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
NVV38103Medicare PIN