Provider Demographics
NPI:1174201933
Name:STRADER, JONATHON ALLEN
Entity type:Individual
Prefix:
First Name:JONATHON
Middle Name:ALLEN
Last Name:STRADER
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 1:7058 BOWLES CREEK ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2508
Mailing Address - Country:US
Mailing Address - Phone:434-579-0207
Mailing Address - Fax:
Practice Address - Street 1:7040 LAREDO ST STE K
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3044
Practice Address - Country:US
Practice Address - Phone:248-765-5674
Practice Address - Fax:702-446-8034
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner