Provider Demographics
NPI:1164895835
Name:MARSHALL, LARS ANDREW (RRT)
Entity Type:Individual
Prefix:MR
First Name:LARS
Middle Name:ANDREW
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 VALLEY FORGE AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-5231
Mailing Address - Country:US
Mailing Address - Phone:702-540-5696
Mailing Address - Fax:
Practice Address - Street 1:207 VALLEY FORGE AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-5231
Practice Address - Country:US
Practice Address - Phone:702-540-5696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRC2606227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered