MEDICARE: THERANATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center	2003398.062-122	NV

General Provider Information

NPI Number	:	1629589320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERANATION LLC

Provider Business Mailing Address
First Line	:	8910 W TROPICANA AVE STE 6
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8131
Country	:	US
Telephone Number	:	702-829-3435
Fax Number	:

Provider Business Practice Location Address
First Line	:	8910 W TROPICANA AVE STE 6
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8131
Country	:	US
Telephone Number	:	702-829-3435
Fax Number	:	888-498-7689

Authorized Official
Title or Position	:	BUSINESS OWNER
Name	:	DR. HARRISON G DIEP
Credential	:	DPT
Telephone Number	:	702-513-4247

Provider Enumeration Date	:	10/20/2017
Last Update Date	:	03/17/2018

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Directions to “THERANATION LLC ” Practice Location

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