Provider Demographics
NPI:1629589320
Name:THERANATION LLC
Entity Type:Organization
Organization Name:THERANATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRISON
Authorized Official - Middle Name:G
Authorized Official - Last Name:DIEP
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:702-513-4247
Mailing Address - Street 1:8910 W TROPICANA AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8131
Mailing Address - Country:US
Mailing Address - Phone:702-829-3435
Mailing Address - Fax:
Practice Address - Street 1:8910 W TROPICANA AVE STE 6
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8131
Practice Address - Country:US
Practice Address - Phone:702-829-3435
Practice Address - Fax:888-498-7689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2003398.062-122261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation