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NPI Code Detail

MEDICARE: DR. JONATHAN BAUTISTA DPT

MEDICARE: DR. JONATHAN BAUTISTA DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist6522NV

General Provider Information

NPI Number : 1053142463
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JONATHAN BAUTISTA DPT
Provider Business Mailing Address
First Line : 6631 CREEPING THYME ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-4801
Country : US
Telephone Number : 775-742-7133
Fax Number :
Provider Business Practice Location Address
First Line : 4000 S EASTERN AVE STE 150
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-0840
Country : US
Telephone Number : 725-726-7847
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2024
Last Update Date : 08/12/2024

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