Provider Demographics
NPI:1558668806
Name:BEDOLLA, THOMAS JR
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BEDOLLA
Suffix:JR
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 1:4220 E CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-5318
Mailing Address - Country:US
Mailing Address - Phone:702-489-4091
Mailing Address - Fax:
Practice Address - Street 1:4220 E CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-5318
Practice Address - Country:US
Practice Address - Phone:702-489-4091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner