Healthcare Provider Details

I. General information

NPI: 1154625457
Provider Name (Legal Business Name): MICHAEL THROWER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6396 MCLEOD DR STE 6-8
LAS VEGAS NV
89120-4428
US

IV. Provider business mailing address

4660 S EASTERN AVE STE 104A
LAS VEGAS NV
89119-6137
US

V. Phone/Fax

Practice location:
  • Phone: 702-912-0600
  • Fax:
Mailing address:
  • Phone: 702-451-7542
  • Fax: 702-450-4239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: