Provider Demographics
NPI:1396907937
Name:SLAUGHTER, LES (LMT,MMP,TRT)
Entity type:Individual
Prefix:MR
First Name:LES
Middle Name:
Last Name:SLAUGHTER
Suffix:
Gender:M
Credentials:LMT,MMP,TRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6317 PORTOLA RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-3920
Mailing Address - Country:US
Mailing Address - Phone:702-807-8137
Mailing Address - Fax:702-658-0883
Practice Address - Street 1:3211 N TENAYA WAY
Practice Address - Street 2:SUITE #110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7439
Practice Address - Country:US
Practice Address - Phone:702-807-8137
Practice Address - Fax:702-658-0883
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT0089225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist