Provider Demographics
NPI:1144565144
Name:FREE, REGINALD KEVIN
Entity Type:Individual
Prefix:
First Name:REGINALD
Middle Name:KEVIN
Last Name:FREE
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 1:1342 ALVO CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-5102
Mailing Address - Country:US
Mailing Address - Phone:469-667-0950
Mailing Address - Fax:
Practice Address - Street 1:1342 ALVO CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-5102
Practice Address - Country:US
Practice Address - Phone:469-667-0950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-01
Last Update Date:2012-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty