MEDICARE: JASON WALLBANK

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
1	225200000X	Physical Therapy Assistant	A-1163	NV

General Provider Information

NPI Number	:	1851271563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON WALLBANK

Provider Business Mailing Address
First Line	:	3349 CALDORA LN
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89044-1764
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3920 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1631
Country	:	US
Telephone Number	:	877-757-8353
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2025
Last Update Date	:	09/03/2025

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Directions to “ JASON WALLBANK ” Practice Location

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