Provider Demographics
NPI:1114271822
Name:WHALEY, REGIS ALEXANDER
Entity Type:Individual
Prefix:
First Name:REGIS
Middle Name:ALEXANDER
Last Name:WHALEY
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 1:5230 W PATRICK LN
Mailing Address - Street 2:STE. 140
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-2851
Mailing Address - Country:US
Mailing Address - Phone:702-570-5100
Mailing Address - Fax:702-570-5104
Practice Address - Street 1:5230 W PATRICK LN
Practice Address - Street 2:STE. 140
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2851
Practice Address - Country:US
Practice Address - Phone:702-570-5100
Practice Address - Fax:702-570-5104
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner