NPIMap

Organization Active NPI

Family and Sports Physical Therapy

  • Physical Therapy Clinic/Center
  • Las Vegas, NV
National Provider Identifier
1912082140
Registry record updated Apr 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
FAMILY AND SPORTS PHYSICAL THERAPY
Practice address
7351 Prairie Falcon Rd Ste 100
Las Vegas, NV 89128-0820
Phone
(702) 968-0520
Fax
(702) 968-0521
NPI assigned
Oct 26, 2006
Last updated
Apr 21, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2015

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

Authorized official

Name
Mr. Jeff Dietrich, PTNPI 1073578548
Title
Director, Secretary
Phone
(702) 968-0520

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 Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

7351 Prairie Falcon Rd Ste 100
Las Vegas, NV 89128-0820

Mailing address

7351 Prairie Falcon Rd Ste 100
Las Vegas, NV 89128-0820
Phone (702) 968-0520

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040714000954 NV Part B Supplier - Clinic/Group Practice 1355320359 Receives reassigned benefits from 5 practitioners
Practice locations: Las Vegas, NV

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429574400000",
    "number": "1912082140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7351 PRAIRIE FALCON RD STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280820",
            "telephone_number": "702-968-0520",
            "fax_number": "702-968-0521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7351 PRAIRIE FALCON RD STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280820",
            "telephone_number": "702-968-0520",
            "fax_number": "702-968-0521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY AND SPORTS PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2015-04-21",
        "status": "A",
        "authorized_official_last_name": "DIETRICH",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "DIRECTOR, SECRETARY",
        "authorized_official_telephone_number": "702-968-0520",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Apr 21, 2015; 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.