Provider Demographics
NPI:1790667194
Name:MACK, BRIA
Entity type:Individual
Prefix:
First Name:BRIA
Middle Name:
Last Name:MACK
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10086 PACIFIC PEAK ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-2901
Mailing Address - Country:US
Mailing Address - Phone:702-677-9918
Mailing Address - Fax:
Practice Address - Street 1:4480 MEADOWS LN UNIT 519A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-3128
Practice Address - Country:US
Practice Address - Phone:702-677-9918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner