Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A-0456 | NV |
NPI | 1003386533 |
---|---|
Provider Name | Damon Elliott |
First Address | Las Vegas, NV 89117-8426 |
Second Address | Las Vegas, NV 89117-8426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2018 |
Last Update Date | 27/11/2018 |