Individual
DOMINIC MALIK TERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7473 W LAKE MEAD BLVD STE 111, LAS VEGAS, NV 89128-0265
(702) 417-1064
Mailing address
7473 W LAKE MEAD BLVD STE 111, LAS VEGAS, NV 89128-0265
(702) 417-1064
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2020
—
NV
Enumeration date
01/13/2021
Last updated
01/13/2021
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