Provider Demographics
NPI:1255611737
Name:PRYOR, PHILLIP LOREN JR
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:LOREN
Last Name:PRYOR
Suffix:JR
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 1:3172 N RAINBOW BLVD
Mailing Address - Street 2:#327
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4534
Mailing Address - Country:US
Mailing Address - Phone:702-542-2277
Mailing Address - Fax:
Practice Address - Street 1:3172 N RAINBOW BLVD
Practice Address - Street 2:#327
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-4534
Practice Address - Country:US
Practice Address - Phone:702-542-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner