NPIMap

Organization Active NPI

Executive Fitness Inc

Doing business as Timothy B Soder Physical Therapy

  • Physical Therapist
  • Las Vegas, NV
National Provider Identifier
1881710192
Registry record updated Jan 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1000002-322 Issued in NV
Legal business name
EXECUTIVE FITNESS INC
Doing business as
Timothy B Soder Physical Therapy
Practice address
6440 Medical Center St
Suite 100
Las Vegas, NV 89148-2404
Phone
(702) 222-1000
Fax
(702) 222-9448
NPI assigned
Mar 21, 2007
Last updated
Jan 9, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2008

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

Authorized official

Name
Mr. Timothy Brian Soder, MSPTNPI 1174648935
Title
Director
Phone
(702) 222-1000

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1000002-322 NV Primary

Addresses

Primary practice location

6440 Medical Center St
Suite 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

  • Timothy B Soder 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
O20040720000501 NV Part B Supplier - Clinic/Group Practice 9638158884 Receives reassigned benefits from 12 practitioners
Practice locations: Henderson, NV; Las Vegas, NV

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.

Locations

2779 W Horizon Ridge Pkwy
Ste 100
Henderson, NV 89052
Phone (702) 222-1000

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

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199836800000",
    "number": "1881710192",
    "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",
            "address_2": "SUITE 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": "2007-03-21",
        "last_updated": "2008-01-09",
        "status": "A",
        "authorized_official_last_name": "SODER",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "BRIAN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "702-222-1000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NV",
            "license": "1000002-322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Timothy B 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 Jan 9, 2008; 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.