Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013208891 |
---|---|
Provider Name | Leah Soares |
First Address | Las Vegas, NV 89178-3811 |
Second Address | Las Vegas, NV 89178-3811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2011 |
Last Update Date | 27/04/2011 |