Provider Demographics
NPI:1134684491
Name:WHITFIELD, DRECHIR JUANITA (LMT)
Entity Type:Individual
Prefix:
First Name:DRECHIR
Middle Name:JUANITA
Last Name:WHITFIELD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6625 S VALLEY VIEW BLVD STE 414
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-4559
Mailing Address - Country:US
Mailing Address - Phone:702-984-0396
Mailing Address - Fax:
Practice Address - Street 1:6625 S VALLEY VIEW BLVD STE 414
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-4559
Practice Address - Country:US
Practice Address - Phone:702-984-0396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.8916225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist