Provider Demographics
NPI:1811971815
Name:STUDER, MICHAEL T (PT, DPT, FAPTA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:STUDER
Suffix:
Gender:M
Credentials:PT, DPT, FAPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 N TENAYA WAY STE 180
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1110
Mailing Address - Country:US
Mailing Address - Phone:702-240-2952
Mailing Address - Fax:702-243-0482
Practice Address - Street 1:2650 N TENAYA WAY STE 180
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1110
Practice Address - Country:US
Practice Address - Phone:702-240-2952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2706225100000X
OR027062251N0400X
NV48102251N0400X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213310Medicaid
Q33193Medicare UPIN
ORR130326Medicare UPIN
OR213310Medicaid