NPIMap

Sean Ellis

Individual provider Active NPI Physical Therapist · Henderson, NV

NPI 1912014754 · NPPES record last updated Oct 18, 2021

Key facts

NPI
1912014754
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapist 225100000X
License
2517 (NV)
Practice address
2904 W Horizon Ridge Pkwy Ste 121
Henderson, NV 89052-5016
Phone
(702) 897-7331
Fax
(702) 897-6801
NPI assigned
Aug 25, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 17

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare Care Compare profile

Specialty
Physical Therapist in Private Practice
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dignity Select Nevada LLC (111 clinicians)

Practice addresses (Care Compare)

400 N Stephanie St
Suite 310
Henderson, NV 89014-6608
Phone (702) 454-1162

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NV

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20120508000197 NV Practitioner - Physical Therapist in Private Practice 1850304882 Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD)
Yes

State licenses

LicenseStateTypeSpecialty
2517NVMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Dignity Select Nevada, LLC Current
since Apr 23, 2019		 Accepting new patients
Dignity Select Nevada LLC Physical Therapist Current Accepting new patients
Dignity Select Nevada LLC Current
since Apr 23, 2019		 Accepting new patients
Select Physical Therapy Holdings Inc Past Accepting new patients
Select Physical Therapy Holdings Inc Past Accepting new patients

Locations

2651 Paseo Verde Pkwy
Ste 170
Henderson, NV 89074
Phone (702) 312-4878

750 Coronado Center Dr
Ste 140
Henderson, NV 89052
Phone (702) 312-4878

2850 W Horizon Ridge Pkwy
Ste 320
Henderson, NV 89052
Phone (702) 564-4116

1395 Raiders Way
Ste 140
Henderson, NV 89052
Phone (725) 241-6800

555 College Dr
Ste C
Henderson, NV 89015
Phone (725) 254-1251

2904 W Horizon Ridge Pkwy
Ste 121
Henderson, NV 89052
Phone (702) 897-7331

400 N Stephanie St
Ste 310
Henderson, NV 89014
Phone (702) 360-9142

2110 E Flamingo Rd
Ste 314
Las Vegas, NV 89119
Phone (702) 813-1237

4855 Blue Diamond Rd
Ste 210
Las Vegas, NV 89139
Phone (725) 207-3770

10630 Dean Martin Dr
Ste 120
Las Vegas, NV 89141
Phone (725) 254-1330

821 N Nellis Blvd
Ste 130
Las Vegas, NV 89110
Phone (702) 227-4447

1776 E Warm Springs Rd
Ste 106
Las Vegas, NV 89119
Phone (702) 603-4110

8740 W Charleston Blvd
Ste 12
Las Vegas, NV 89117
Phone (725) 257-6560

9880 W Flamingo Rd
Ste 260
Las Vegas, NV 89147
Phone (702) 360-9142

8675 W Rome Blvd
Ste 140
Las Vegas, NV 89149
Phone (725) 206-7929

6048 S Durango Dr
Ste 100
Las Vegas, NV 89113
Phone (702) 260-6238

2650 N Tenaya Way
Ste 180
Las Vegas, NV 89128
Phone (702) 240-2952

4980 W Sahara Ave
Ste 260
Las Vegas, NV 89146
Phone (702) 240-2952

1550 W Craig Rd
Ste 210
North Las Vegas, NV 89032
Phone (702) 343-0623

2550 Nature Park Dr
Ste 250
North Las Vegas, NV 89084
Phone (702) 524-8555

4714 Gettysburg Rd
Mechanicsburg, PA 17055
Phone (888) 735-6332

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X
Physical Therapist 225100000X 2517 NV Yes

Addresses

Primary practice location

2904 W Horizon Ridge Pkwy Ste 121
Henderson, NV 89052-5016

Mailing address

2904 W Horizon Ridge Pkwy Ste 121
Henderson, NV 89052-5016
Phone (702) 897-7331

Other identifiers

IdentifierTypeStateIssuer
2001017939OtherMOLICENSE #

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 18, 2021.

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634515200000",
    "number": "1912014754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2904 W HORIZON RIDGE PKWY STE 121",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890525016",
            "telephone_number": "702-897-7331",
            "fax_number": "702-897-6801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2904 W HORIZON RIDGE PKWY STE 121",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890525016",
            "telephone_number": "702-897-7331",
            "fax_number": "702-897-6801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "SEAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2021-10-18",
        "certification_date": "2021-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NV",
            "license": "2517",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "2001017939",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

All providers in Henderson, NV · Physical Therapist in Nevada

Sources for this page

Verify at the official NPI Registry.