Provider Demographics
NPI:1952361107
Name:PENSIVY, SCOTT ROBERT (PT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ROBERT
Last Name:PENSIVY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9070 W CHEYENNE AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-8934
Mailing Address - Country:US
Mailing Address - Phone:702-655-8535
Mailing Address - Fax:702-656-5863
Practice Address - Street 1:9070 W CHEYENNE AVE
Practice Address - Street 2:STE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-8934
Practice Address - Country:US
Practice Address - Phone:702-655-8535
Practice Address - Fax:702-656-5863
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV101519Medicare ID - Type Unspecified