NPIMap

Organization Active NPI

Origin Physical Therapy PLLC

Doing business as Origin Physical Therapy

  • Physical Therapy Clinic/Center
  • Las Vegas, NV
National Provider Identifier
1790351088
Registry record updated Oct 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
ORIGIN PHYSICAL THERAPY PLLC
Doing business as
Origin Physical Therapy
Practice address
6480 S Tenaya Way Ste 100
Las Vegas, NV 89113-6655
Phone
(702) 623-8555
Fax
(702) 623-8545
NPI assigned
May 27, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2025

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

Authorized official

Name
Anthony Ray Tabor, DPTNPI 1194062877
Title
Director of Operations
Phone
(702) 623-8555

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

6480 S Tenaya Way Ste 100
Las Vegas, NV 89113-6655

Mailing address

6480 S Tenaya Way Ste 100
Las Vegas, NV 89113-6655
Phone (702) 623-8555

Other names 1

  • ORIGIN PHYSICAL THERAPY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210913000828 NV Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5294131579 Receives reassigned benefits from 5 practitioners
Practice locations: Las Vegas, NV

National Provider Directory

National Provider Directory

Locations

6480 S Tenaya Way
Ste 100
Las Vegas, NV 89113
Phone (702) 623-5555

6410 S Tenaya Way
Ste 100
Las Vegas, NV 89113

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1622073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761004800000",
    "number": "1790351088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6480 S TENAYA WAY STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891136655",
            "telephone_number": "702-623-8555",
            "fax_number": "702-623-8545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6480 S TENAYA WAY STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891136655",
            "telephone_number": "702-623-8555",
            "fax_number": "702-623-8545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORIGIN PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-27",
        "last_updated": "2025-10-21",
        "certification_date": "2025-10-21",
        "status": "A",
        "authorized_official_last_name": "TABOR",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "702-623-8555",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ORIGIN PHYSICAL THERAPY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ORIGIN 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 Oct 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.