Individual
RICHARD FAIRCLOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
636 POANA AVE, NORTH LAS VEGAS, NV 89032-7694
(702) 517-1124
Mailing address
636 POANA AVE, NORTH LAS VEGAS, NV 89032-7694
(702) 517-1124
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
06/09/2014
Last updated
06/09/2014
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