Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013207281 |
---|---|
Provider Name | Damian Coles |
First Address | Las Vegas, NV 89121-5027 |
Second Address | Las Vegas, NV 89121-5027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2011 |
Last Update Date | 08/04/2011 |