Provider Demographics
NPI:1245571041
Name:GAITHER, COREY RAMON
Entity type:Individual
Prefix:MR
First Name:COREY
Middle Name:RAMON
Last Name:GAITHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10597 HINESVILLE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-6466
Mailing Address - Country:US
Mailing Address - Phone:702-518-9152
Mailing Address - Fax:702-534-4956
Practice Address - Street 1:10597 HINESVILLE CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-6466
Practice Address - Country:US
Practice Address - Phone:702-518-9152
Practice Address - Fax:702-534-4956
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0000008413225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner