Active NPI
Gavin E Watabayashi, DPT
- Physical Therapy Assistant
- Las Vegas, NV
National Provider Identifier
1659100485
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 6485
- Practice address
- 1845 Village Center Cir
Las Vegas, NV 89134-6369 - Phone
- (702) 723-9006
- Fax
- (702) 664-0466
- NPI assigned
- Jul 30, 2024
- Sex
- Male
- 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 | 6485 | NV | Primary |
Addresses
Primary practice location
1845 Village Center Cir
Las Vegas, NV 89134-6369
Mailing address
1845 Village Center Cir
Las Vegas, NV 89134-6369
Phone (702) 723-9006
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240821003070 | NV | Practitioner - Physical Therapist in Private Practice | 8820536881 |
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2024
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1845 Village Ctr Cir
Las Vegas, NV 89134
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6485 | NV | MD | Neurological Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1722297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722297600000",
"number": "1659100485",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1845 VILLAGE CENTER CIR",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891346369",
"telephone_number": "702-723-9006",
"fax_number": "702-664-0466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1845 VILLAGE CENTER CIR",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891346369",
"telephone_number": "702-723-9006",
"fax_number": "702-664-0466"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATABAYASHI",
"first_name": "GAVIN",
"middle_name": "E",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-07-30",
"last_updated": "2024-07-30",
"certification_date": "2024-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NV",
"license": "6485",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
- Joachim Wassom, RPH
- Alexia Wasson
- Krista Wasson
- Gregory J Wastek, M.D., PH.D.
- Wendy C Wasula
- Shizu Watabe
- Watanabe Diamond Dental Group, Professional Corporation
- Watanabe Ranch Plaza Dental Group, PC
- Watanabe Rocksprings Dental Group, PC
- Watanabe Shadow Mountain Dental Group, Professional Corporation
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.