Provider Demographics
NPI:1427061928
Name:STRAUB, LARRY (PT)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:STRAUB
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 N NELLIS BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-5387
Mailing Address - Country:US
Mailing Address - Phone:702-452-4563
Mailing Address - Fax:702-452-6704
Practice Address - Street 1:821 N NELLIS BLVD STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5387
Practice Address - Country:US
Practice Address - Phone:702-452-4563
Practice Address - Fax:702-452-6704
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPT011786LOtherSTATE LICENSE