Provider Demographics
NPI:1861561227
Name:FALLON PHYSICAL THERAPY
Entity type:Organization
Organization Name:FALLON PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:775-423-5233
Mailing Address - Street 1:2180 RENO HWY
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-2629
Mailing Address - Country:US
Mailing Address - Phone:775-423-5233
Mailing Address - Fax:775-423-2101
Practice Address - Street 1:2180 RENO HWY
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-2629
Practice Address - Country:US
Practice Address - Phone:775-423-5233
Practice Address - Fax:775-423-2101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RODNEY D. STEWART
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-07
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1312225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100505290Medicaid