Provider Demographics
NPI:1952597049
Name:STREIT, TAVENER J (DPT)
Entity type:Individual
Prefix:
First Name:TAVENER
Middle Name:J
Last Name:STREIT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6630 S MCCARRAN BLVD
Mailing Address - Street 2:SUITE A-6
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6135
Mailing Address - Country:US
Mailing Address - Phone:775-828-2866
Mailing Address - Fax:775-828-2891
Practice Address - Street 1:6630 S MCCARRAN BLVD
Practice Address - Street 2:SUITE A-6
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6135
Practice Address - Country:US
Practice Address - Phone:775-828-2866
Practice Address - Fax:775-828-2891
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV21782251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic