Provider Demographics
NPI:1043797772
Name:HENRY, STEVE (ATP/SMS)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:HENRY
Suffix:
Gender:M
Credentials:ATP/SMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4912 MONDELL RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-2213
Mailing Address - Country:US
Mailing Address - Phone:702-235-9023
Mailing Address - Fax:
Practice Address - Street 1:4912 MONDELL RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2213
Practice Address - Country:US
Practice Address - Phone:702-235-9023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
5426225CA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CA2500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Supplier