Provider Demographics
NPI:1053825125
Name:THRASHER, HENRY (SOLE PROVIDER)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:
Last Name:THRASHER
Suffix:
Gender:M
Credentials:SOLE PROVIDER
Other - Prefix:MR
Other - First Name:HENRY
Other - Middle Name:
Other - Last Name:THRASHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SOLE PROVIDER
Mailing Address - Street 1:3335 HAUCK ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-8022
Mailing Address - Country:US
Mailing Address - Phone:725-201-2727
Mailing Address - Fax:
Practice Address - Street 1:3335 HAUCK ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-8022
Practice Address - Country:US
Practice Address - Phone:725-201-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver