NPIMap

Organization Active NPI

Functional Neuro Rehab, LLC

  • Rehabilitation Clinic/Center
  • Henderson, NV
National Provider Identifier
1023612066
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
FUNCTIONAL NEURO REHAB, LLC
Practice address
650 Whitney Ranch Dr Apt 1511
Henderson, NV 89014-2615
Phone
(253) 261-8436
NPI assigned
Nov 30, 2020
Last updated
Sep 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shannon Mariah Olivero-Chew, O.T.NPI 1497248249
Title
Owner
Phone
(575) 479-7056

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

650 Whitney Ranch Dr Apt 1511
Henderson, NV 89014-2615

Mailing address

304 S Jones Blvd Ste 3511
Las Vegas, NV 89107-2623
Phone (575) 479-7056

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1023612066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 S JONES BLVD STE 3511",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891072623",
            "telephone_number": "575-479-7056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 WHITNEY RANCH DR APT 1511",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890142615",
            "telephone_number": "253-261-8436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL NEURO REHAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-30",
        "last_updated": "2023-09-06",
        "certification_date": "2020-11-30",
        "status": "A",
        "authorized_official_last_name": "OLIVERO-CHEW",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "MARIAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "575-479-7056",
        "authorized_official_credential": "O.T."
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.