Provider Demographics
NPI:1912976234
Name:SUAREZ, EDWIN (MSPT)
Entity Type:Individual
Prefix:MR
First Name:EDWIN
Middle Name:
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 E SUNSET RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-7233
Mailing Address - Country:US
Mailing Address - Phone:702-368-6778
Mailing Address - Fax:702-368-6775
Practice Address - Street 1:3620 E SUNSET RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-6222
Practice Address - Country:US
Practice Address - Phone:702-368-6778
Practice Address - Fax:702-368-6775
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCC8585OtherBLUECROSS BLUESHEILD
NV100500010Medicaid
NVCC8585OtherBLUECROSS BLUESHEILD
NV100500010Medicaid