Healthcare Provider Details

I. General information

NPI: 1497862809
Provider Name (Legal Business Name): FREDERICK DUBOIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S RANCHO DR STE D
LAS VEGAS NV
89106-4849
US

IV. Provider business mailing address

1845 WALKER LN
HENDERSON NV
89014-4015
US

V. Phone/Fax

Practice location:
  • Phone: 702-878-2244
  • Fax:
Mailing address:
  • Phone: 702-217-2346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: