1114972973 NPI number — PACE PHYSICAL THERAPY & SPINE FITNESS

Table of content: (NPI 1114972973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114972973 NPI number — PACE PHYSICAL THERAPY & SPINE FITNESS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACE PHYSICAL THERAPY & SPINE FITNESS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LAURIE E NEMES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114972973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
911 NORTH BUFFALO DR
Provider Second Line Business Mailing Address:
STE 107
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89128-0380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-255-7223
Provider Business Mailing Address Fax Number:
702-255-6211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
911 NORTH BUFFALO DR
Provider Second Line Business Practice Location Address:
STE 107
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89128-0380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-255-7223
Provider Business Practice Location Address Fax Number:
702-255-6211
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEMES
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
702-255-7223

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  0506 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 1512 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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