Provider Demographics
NPI:1639909021
Name:ZAHIROVIC, KEDRIAN G (LMT)
Entity type:Individual
Prefix:
First Name:KEDRIAN
Middle Name:G
Last Name:ZAHIROVIC
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:ZAHIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:830 N LAMB BLVD SPC 108
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-5450
Mailing Address - Country:US
Mailing Address - Phone:702-530-2215
Mailing Address - Fax:
Practice Address - Street 1:3950 E SUNSET RD STE 118
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4906
Practice Address - Country:US
Practice Address - Phone:775-515-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.10105225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist