Provider Demographics
NPI:1093080178
Name:DREAS, MALISSASUE VALENTINE
Entity Type:Individual
Prefix:MS
First Name:MALISSASUE
Middle Name:VALENTINE
Last Name:DREAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MALISSA
Other - Middle Name:VALENTINE
Other - Last Name:DREAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4160 S PECOS RD STE 17
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5027
Mailing Address - Country:US
Mailing Address - Phone:702-396-3464
Mailing Address - Fax:
Practice Address - Street 1:4160 S PECOS RD STE 17
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5027
Practice Address - Country:US
Practice Address - Phone:702-396-3464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner