NPIMap

Organization Active NPI

Executive Fitness Inc

Doing business as Tim Soder Physical Therapy

  • Specialist
  • Las Vegas, NV
National Provider Identifier
1144552316
Registry record updated Feb 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
2408 Issued in NV
Legal business name
EXECUTIVE FITNESS INC
Doing business as
Tim Soder Physical Therapy
Practice address
6440 Medical Center St Ste 100
Las Vegas, NV 89148-2404
Phone
(702) 222-1000
Fax
(702) 222-9448
NPI assigned
Feb 12, 2010
Last updated
Feb 12, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2010

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

Authorized official

Name
Jackie Dickinson
Title
Office Manager
Phone
(702) 222-1000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 2408 NV Primary

Addresses

Primary practice location

6440 Medical Center St Ste 100
Las Vegas, NV 89148-2404

Mailing address

6440 Medical Center St Ste 100
Las Vegas, NV 89148-2404
Phone (702) 222-1000

Other names 1

  • TIM SODER PHYSICAL THERAPY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Executive Fitness Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 34

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.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1265932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265932800000",
    "number": "1144552316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6440 MEDICAL CENTER ST STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891482404",
            "telephone_number": "702-222-1000",
            "fax_number": "702-222-9448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6440 MEDICAL CENTER ST STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891482404",
            "telephone_number": "702-222-1000",
            "fax_number": "702-222-9448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE FITNESS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-12",
        "last_updated": "2010-02-12",
        "status": "A",
        "authorized_official_last_name": "DICKINSON",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "702-222-1000"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NV",
            "license": "2408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TIM SODER PHYSICAL THERAPY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2010; 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.