Active NPI
Marykay Manaclay, PTA
- Physical Therapy Assistant
- Henderson, NV
National Provider Identifier
1043884042
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- A-1249
- Practice address
- 2821 W Horizon Ridge Pkwy Ste 101
Henderson, NV 89052-4429 - Phone
- (702) 893-3333
- Fax
- (702) 893-0960
- NPI assigned
- May 14, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | A-1249 | NV | Primary |
Addresses
Primary practice location
2821 W Horizon Ridge Pkwy Ste 101
Henderson, NV 89052-4429
Mailing address
2821 W Horizon Ridge Pkwy Ste 101
Henderson, NV 89052-4429
Phone (702) 893-3333
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A-1249 | NV | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620950400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620950400000",
"number": "1043884042",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2821 W HORIZON RIDGE PKWY STE 101",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890524429",
"telephone_number": "702-893-3333",
"fax_number": "702-893-0960"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2821 W HORIZON RIDGE PKWY STE 101",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890524429",
"telephone_number": "702-893-3333",
"fax_number": "702-893-0960"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANACLAY",
"first_name": "MARYKAY",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-05-14",
"last_updated": "2021-05-14",
"certification_date": "2021-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NV",
"license": "A-1249",
"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 May 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.