Provider Demographics
NPI:1598040925
Name:MENTZER, MATTHEW (RRT, AE-C)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MENTZER
Suffix:
Gender:M
Credentials:RRT, AE-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PINYON TREE CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-1518
Mailing Address - Country:US
Mailing Address - Phone:702-612-2223
Mailing Address - Fax:
Practice Address - Street 1:8170 W SAHARA AVE STE 106
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1981
Practice Address - Country:US
Practice Address - Phone:702-612-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRC19712279E1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279E1000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredEducational