Provider Demographics
NPI:1790082972
Name:MIKELS, TROY S (LSW)
Entity Type:Individual
Prefix:MR
First Name:TROY
Middle Name:S
Last Name:MIKELS
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 N BUFFALO DR UNIT 1047
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-2642
Mailing Address - Country:US
Mailing Address - Phone:702-242-1963
Mailing Address - Fax:
Practice Address - Street 1:1830 N BUFFALO DR UNIT 1047
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-2642
Practice Address - Country:US
Practice Address - Phone:702-242-1963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner