Provider Demographics
NPI:1457659344
Name:HAILEY, PETE SR
Entity Type:Individual
Prefix:
First Name:PETE
Middle Name:
Last Name:HAILEY
Suffix:SR
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 1:650 E AZURE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-6885
Mailing Address - Country:US
Mailing Address - Phone:702-401-9615
Mailing Address - Fax:
Practice Address - Street 1:650 E AZURE AVE APT 1041
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-6871
Practice Address - Country:US
Practice Address - Phone:702-401-9615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner