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General NPI Number Information
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NPI Number | 1245571041
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Entity Type | Individual
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Provider Name | MR. COREY RAMON GAITHER
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Gender | Male
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 10597 HINESVILLE CT
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City | LAS VEGAS
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State | NV
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Zip | 89129-6466
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Country | US
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Telephone | 702-518-9152
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Fax | 702-534-4956
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Provider Business Mailing Address
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Address Line | 10597 HINESVILLE CT
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City | LAS VEGAS
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State | NV
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Zip | 89129-6466
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Country | US
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Telephone | 702-518-9152
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Fax | 702-534-4956
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | 0000008413
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License Number State | NV
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