Provider Demographics
NPI:1336586866
Name:DEISTER, TESSA
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:DEISTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:
Other - Last Name:MOSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10325 ADAMS CHASE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-6993
Mailing Address - Country:US
Mailing Address - Phone:702-624-1736
Mailing Address - Fax:
Practice Address - Street 1:6889 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-4687
Practice Address - Country:US
Practice Address - Phone:702-434-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner