Provider Demographics
NPI:1518280718
Name:DAIMONJI, RAE-ANN (MSPT)
Entity Type:Individual
Prefix:MS
First Name:RAE-ANN
Middle Name:
Last Name:DAIMONJI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7660 RIO VISTA ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-3363
Mailing Address - Country:US
Mailing Address - Phone:702-396-4342
Mailing Address - Fax:702-396-4342
Practice Address - Street 1:7660 RIO VISTA ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-3363
Practice Address - Country:US
Practice Address - Phone:702-396-4342
Practice Address - Fax:702-396-4342
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist