Provider Demographics
NPI:1144675125
Name:SPORTS & PERFORMANCE PHYSICAL THERAPY
Entity type:Organization
Organization Name:SPORTS & PERFORMANCE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, ATC
Authorized Official - Phone:775-470-5881
Mailing Address - Street 1:100 W LIBERTY ST
Mailing Address - Street 2:SUITE 170
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501-1962
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 W LIBERTY ST
Practice Address - Street 2:SUITE 170
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-1962
Practice Address - Country:US
Practice Address - Phone:415-794-3113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3163261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy