Provider Demographics
NPI:1013106798
Name:ARAGON, VENANCIA M (PT)
Entity type:Individual
Prefix:
First Name:VENANCIA
Middle Name:M
Last Name:ARAGON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:VENANCIA
Other - Middle Name:THERESA
Other - Last Name:ARAGON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:948 HICKORY PARK ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-7596
Mailing Address - Country:US
Mailing Address - Phone:702-290-9262
Mailing Address - Fax:
Practice Address - Street 1:8174 LAS VEGAS BLVD S STE 109-150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-1029
Practice Address - Country:US
Practice Address - Phone:702-883-9528
Practice Address - Fax:702-852-5715
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2175225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist