Provider Demographics
NPI:1730732454
Name:HEPPE, TREVER (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:TREVER
Middle Name:
Last Name:HEPPE
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 N BUFFALO DR UNIT 170
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-3637
Mailing Address - Country:US
Mailing Address - Phone:702-660-2694
Mailing Address - Fax:702-750-1372
Practice Address - Street 1:1525 E WINDMILL LN STE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-1903
Practice Address - Country:US
Practice Address - Phone:702-832-0258
Practice Address - Fax:702-564-4838
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist