Basic Information
| Provider Information | |||||||||
| NPI: | 1730692070 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAUZY | ||||||||
| FirstName: | TREVOR | ||||||||
| MiddleName: | MACLANE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 129 W LAKE MEAD PKWY STE 2 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890157055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025646712 | ||||||||
| FaxNumber: | 7025644838 | ||||||||
| Practice Location | |||||||||
| Address1: | 129 W LAKE MEAD PKWY STE 2 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890157055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025646712 | ||||||||
| FaxNumber: | 7025644838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 3627 | NV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.