Provider Demographics
NPI:1164524625
Name:BALES, RICHARD L (PT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:L
Last Name:BALES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 GOLDFIRE CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2667
Mailing Address - Country:US
Mailing Address - Phone:702-947-5200
Mailing Address - Fax:702-947-5204
Practice Address - Street 1:2110 E FLAMINGO RD STE 314
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5193
Practice Address - Country:US
Practice Address - Phone:702-947-5200
Practice Address - Fax:702-947-5204
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV252225100000X
NV0252225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003402089Medicaid
NVV36885Medicare PIN
NVV36887Medicare PIN