Provider Demographics
NPI:1508100884
Name:GALLANT, JONAH
Entity Type:Individual
Prefix:
First Name:JONAH
Middle Name:
Last Name:GALLANT
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 1:3752 N WALNUT RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-0322
Mailing Address - Country:US
Mailing Address - Phone:702-813-8677
Mailing Address - Fax:
Practice Address - Street 1:700 LOLA AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-5650
Practice Address - Country:US
Practice Address - Phone:702-813-8677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner