Provider Demographics
NPI:1861051898
Name:ALCANTARA, MARY CHARIS KIRBY BRIONES (PT)
Entity type:Individual
Prefix:
First Name:MARY CHARIS KIRBY
Middle Name:BRIONES
Last Name:ALCANTARA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1848 MORRO VISTA DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-3600
Mailing Address - Country:US
Mailing Address - Phone:702-339-9354
Mailing Address - Fax:
Practice Address - Street 1:9011 SIERRA PALMS WAY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6969
Practice Address - Country:US
Practice Address - Phone:702-227-4477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3988225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty