Provider Demographics
NPI:1669600227
Name:REED, ELLIOTT HOWARD (LMT)
Entity type:Individual
Prefix:MR
First Name:ELLIOTT
Middle Name:HOWARD
Last Name:REED
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5145 RAWHIDE ST
Mailing Address - Street 2:#107
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-4801
Mailing Address - Country:US
Mailing Address - Phone:321-460-2096
Mailing Address - Fax:
Practice Address - Street 1:5145 RAWHIDE ST
Practice Address - Street 2:#107
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-4801
Practice Address - Country:US
Practice Address - Phone:321-460-2096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.3114225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist