Provider Demographics
NPI:1942675731
Name:TRABADO, DEXTER AHUMADA (MSPT, DPT, GCS)
Entity Type:Individual
Prefix:
First Name:DEXTER
Middle Name:AHUMADA
Last Name:TRABADO
Suffix:
Gender:M
Credentials:MSPT, DPT, GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8081 RAMS COLLIDE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-1210
Mailing Address - Country:US
Mailing Address - Phone:347-781-2617
Mailing Address - Fax:
Practice Address - Street 1:9100 W DESERT INN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-6323
Practice Address - Country:US
Practice Address - Phone:725-239-1049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-06
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NJ40QA013510002251G0304X
NV4899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics