Provider Demographics
NPI:1336553171
Name:DESERT PULMONARY REHABILITATION AND DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:DESERT PULMONARY REHABILITATION AND DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:THAO
Authorized Official - Suffix:
Authorized Official - Credentials:BA, RRT, RRT-SDS
Authorized Official - Phone:702-487-5511
Mailing Address - Street 1:2980 S JONES BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5657
Mailing Address - Country:US
Mailing Address - Phone:702-487-5511
Mailing Address - Fax:702-487-5211
Practice Address - Street 1:2980 S JONES BLVD STE C
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5657
Practice Address - Country:US
Practice Address - Phone:702-487-5511
Practice Address - Fax:702-487-5211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X
NVRC346227800000X
NVRC1453227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Multi-Specialty
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGroup - Multi-Specialty