Provider Demographics
NPI:1164821732
Name:DECK, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:DECK
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 1:2475 ROBB DR
Mailing Address - Street 2:APT #1518
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-2871
Mailing Address - Country:US
Mailing Address - Phone:775-230-5396
Mailing Address - Fax:
Practice Address - Street 1:4780 ARVILLE ST
Practice Address - Street 2:SUITE D
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-5402
Practice Address - Country:US
Practice Address - Phone:702-830-9740
Practice Address - Fax:702-830-9741
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner