Provider Demographics
NPI:1538151535
Name:RENO PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:RENO PHYSICAL THERAPY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIDGETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LESAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:775-575-5508
Mailing Address - Street 1:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:FERNLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89408-0511
Mailing Address - Country:US
Mailing Address - Phone:775-575-5508
Mailing Address - Fax:775-575-6655
Practice Address - Street 1:20 N WEST ST
Practice Address - Street 2:
Practice Address - City:FERNLEY
Practice Address - State:NV
Practice Address - Zip Code:89408-9799
Practice Address - Country:US
Practice Address - Phone:775-575-5508
Practice Address - Fax:775-575-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0016, 0441,1242,1523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV=========OtherSTATE OF NEVADA
NV=========OtherSTATE OF NEVADA