Provider Demographics
NPI:1346771821
Name:STRAUSS, IAN A
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:A
Last Name:STRAUSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:IAN
Other - Middle Name:A
Other - Last Name:STRAUSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5302 11TH ST
Mailing Address - Street 2:APT. 140
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-4447
Mailing Address - Country:US
Mailing Address - Phone:602-561-3889
Mailing Address - Fax:
Practice Address - Street 1:5302 11TH ST
Practice Address - Street 2:APT. 140
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416
Practice Address - Country:US
Practice Address - Phone:602-561-3889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-25
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X, 390200000X
IN2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer