Provider Demographics
NPI:1811097884
Name:GARRISON TOTAL PHYSICAL THERAPY AND BACK TO WORK CLINIC, LTD.
Entity type:Organization
Organization Name:GARRISON TOTAL PHYSICAL THERAPY AND BACK TO WORK CLINIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R.P.T.
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-738-0818
Mailing Address - Street 1:1501 LAMOILLE HWY
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-4321
Mailing Address - Country:US
Mailing Address - Phone:775-738-0818
Mailing Address - Fax:775-738-0814
Practice Address - Street 1:1501 LAMOILLE HWY
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-4321
Practice Address - Country:US
Practice Address - Phone:775-738-0818
Practice Address - Fax:775-738-0814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2007-10-12
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
NVV33018Medicare PIN