Provider Demographics
NPI:1336246354
Name:READENCE, DENISE JEAN (LPT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:JEAN
Last Name:READENCE
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1750 N BUFFALO DR
Mailing Address - Street 2:104-434
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-2672
Mailing Address - Country:US
Mailing Address - Phone:702-341-0606
Mailing Address - Fax:702-341-1040
Practice Address - Street 1:321 N BUFFALO DR
Practice Address - Street 2:SUITE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-0308
Practice Address - Country:US
Practice Address - Phone:702-341-0606
Practice Address - Fax:702-341-1040
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV0947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV37294Medicare ID - Type UnspecifiedMEDICARE B