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General NPI Number Information
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NPI Number | 1629589320
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Entity Type | Organization
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Legal Business Name | THERANATION LLC
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Dates
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Enumeration Date | 10/20/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 8910 W TROPICANA AVE STE 6
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City | LAS VEGAS
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State | NV
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Zip | 89147-8131
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Country | US
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Telephone | 702-829-3435
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Fax | 888-498-7689
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Provider Business Mailing Address
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Address Line | 8910 W TROPICANA AVE STE 6
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City | LAS VEGAS
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State | NV
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Zip | 89147-8131
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Country | US
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Telephone | 702-829-3435
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Fax |
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Authorized Official
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Title or Position | BUSINESS OWNER
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Name | DR. HARRISON G DIEP
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Credential | DPT
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Telephone | 702-513-4247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 2003398.062-122
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License Number State | NV
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