Provider Demographics
NPI:1184678773
Name:RADEBE, THABSILE I (MPT)
Entity Type:Individual
Prefix:
First Name:THABSILE
Middle Name:I
Last Name:RADEBE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:INGRID
Other - Middle Name:I
Other - Last Name:RADEBE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPT
Mailing Address - Street 1:1655 E SAHARA AVE
Mailing Address - Street 2:APT 3125
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3417
Mailing Address - Country:US
Mailing Address - Phone:702-672-2127
Mailing Address - Fax:
Practice Address - Street 1:801 S RANCHO DR
Practice Address - Street 2:STE F-4
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3854
Practice Address - Country:US
Practice Address - Phone:702-383-5115
Practice Address - Fax:702-678-6159
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV39352Medicare ID - Type Unspecified