Provider Demographics
NPI:1184233108
Name:FELISE, KIRA (ATC)
Entity type:Individual
Prefix:
First Name:KIRA
Middle Name:
Last Name:FELISE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7701 W ROBINDALE RD UNIT 131
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-4044
Mailing Address - Country:US
Mailing Address - Phone:510-909-3576
Mailing Address - Fax:
Practice Address - Street 1:7701 W ROBINDALE RD UNIT 131
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-4044
Practice Address - Country:US
Practice Address - Phone:510-909-3576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer