Provider Demographics
NPI:1285926832
Name:LEFEAR, PRATHEY WYNN
Entity type:Individual
Prefix:
First Name:PRATHEY
Middle Name:WYNN
Last Name:LEFEAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 W OWENS AVE
Mailing Address - Street 2:STE.6
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2451
Mailing Address - Country:US
Mailing Address - Phone:702-574-7552
Mailing Address - Fax:
Practice Address - Street 1:1230 W OWENS AVE
Practice Address - Street 2:STE.6
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2451
Practice Address - Country:US
Practice Address - Phone:702-574-7552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner