1669552873 NPI number — ANTHEM PHYSICAL THERAPY, INC.

Table of content: ANGELA RENE' MAPLES PTA (NPI 1740862317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669552873 NPI number — ANTHEM PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANTHEM PHYSICAL THERAPY, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1669552873
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1710 W HORIZON RIDGE PKWY STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89012-4901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-489-9217
Provider Business Mailing Address Fax Number:
702-489-9134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11201 S EASTERN AVE
Provider Second Line Business Practice Location Address:
STE 220
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89052-6201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-614-0324
Provider Business Practice Location Address Fax Number:
702-341-0324
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EVANS
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
702-614-0324

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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