Provider Demographics
NPI:1649623810
Name:PACE, STEVEN (PTA)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:PACE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6241 MERCER VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-6512
Mailing Address - Country:US
Mailing Address - Phone:801-814-6505
Mailing Address - Fax:
Practice Address - Street 1:3870 W ANN RD
Practice Address - Street 2:#110
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-4411
Practice Address - Country:US
Practice Address - Phone:702-396-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-0927225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant