Provider Demographics
NPI:1093369837
Name:EMENS, BRAD
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:EMENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 E LAKE MEAD PKWY STE 306
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-6444
Mailing Address - Country:US
Mailing Address - Phone:702-577-5998
Mailing Address - Fax:
Practice Address - Street 1:98 E LAKE MEAD PKWY STE 306
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-6444
Practice Address - Country:US
Practice Address - Phone:702-577-5998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner