Provider Demographics
NPI:1720248008
Name:TIU, FAYNELLA S (PT)
Entity Type:Individual
Prefix:MISS
First Name:FAYNELLA
Middle Name:S
Last Name:TIU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:FAYNELLA
Other - Middle Name:
Other - Last Name:SALABAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2651 CRIMSON CANYON DR STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0843
Mailing Address - Country:US
Mailing Address - Phone:702-623-7102
Mailing Address - Fax:702-850-2841
Practice Address - Street 1:2651 CRIMSON CANYON DR STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0843
Practice Address - Country:US
Practice Address - Phone:702-623-7102
Practice Address - Fax:702-850-2841
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006002067225100000X
NV2276225100000X, 2251C2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonary
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist