Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 1207843 | TX |
Y | 225100000X | Physical Therapist | 3099 | NV |
N | 2251S0007X | Physical Therapist - Sports | 3099 | NV |
N | 2251X0800X | Physical Therapist - Orthopedic | 3099 | NV |
NPI | 1053712166 |
---|---|
Provider Name | Brady Powell |
First Address | North Las Vegas, NV 89030-6328 |
Second Address | North Las Vegas, NV 89030-6328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2014 |
Last Update Date | 27/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053712166 | (05) | NV |