Provider Demographics
NPI:1497006902
Name:INTINARELLI, MICHAEL ANTHONY
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:INTINARELLI
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 1:3095 E PATRICK LN
Mailing Address - Street 2:SUITE 12
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-4932
Mailing Address - Country:US
Mailing Address - Phone:702-483-5919
Mailing Address - Fax:702-483-5546
Practice Address - Street 1:3095 E PATRICK LN
Practice Address - Street 2:SUITE 12
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4932
Practice Address - Country:US
Practice Address - Phone:702-483-5919
Practice Address - Fax:702-483-5546
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner