Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 4143 | NV |
Y | 2251X0800X | Physical Therapist - Orthopedic | 4143 | NV |
NPI | 1497390850 |
---|---|
Provider Name | Dr. Raymond John Mellinger |
First Address | Henderson, NV 89074-8289 |
Second Address | Las Vegas, NV 89129-8712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2019 |
Last Update Date | 08/11/2019 |