Provider Demographics
NPI:1588937460
Name:RADER, VINCENT ALAN
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:ALAN
Last Name:RADER
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 1:9336 QUAIL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-8924
Mailing Address - Country:US
Mailing Address - Phone:702-685-6909
Mailing Address - Fax:702-685-6909
Practice Address - Street 1:9336 QUAIL RIDGE DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-8924
Practice Address - Country:US
Practice Address - Phone:702-685-6909
Practice Address - Fax:702-685-6909
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner