Provider Demographics
NPI:1508391145
Name:THOMAS, ALFRED ALEX
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:ALEX
Last Name:THOMAS
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 1:9037 COTTON ROSE WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-1841
Mailing Address - Country:US
Mailing Address - Phone:702-374-5818
Mailing Address - Fax:
Practice Address - Street 1:9037 COTTON ROSE WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-1841
Practice Address - Country:US
Practice Address - Phone:702-374-5818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner