Provider Demographics
NPI:1497390850
Name:MELLINGER, RAYMOND JOHN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:JOHN
Last Name:MELLINGER
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Gender:M
Credentials:PT, DPT
Other - Prefix:
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Mailing Address - Street 1:7250 PEAK DRIVE
Mailing Address - Street 2:SUITE 118
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128
Mailing Address - Country:US
Mailing Address - Phone:702-893-3333
Mailing Address - Fax:702-839-0095
Practice Address - Street 1:7250 PEAK DRIVE
Practice Address - Street 2:SUITE 118
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:702-893-3333
Practice Address - Fax:702-839-0095
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV41432251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports