Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | A-0183 | NV |
NPI | 1003196650 |
---|---|
Provider Name | Leland Doyle Ratliff II |
First Address | Las Vegas, NV 89129-7259 |
Second Address | Las Vegas, NV 89129-7424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2011 |
Last Update Date | 26/08/2011 |