MEDICARE: MS. JACALYN L MIKLAS PT

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	225100000X	Physical Therapist	2037	NV

General Provider Information

NPI Number	:	1851627582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACALYN L MIKLAS PT

Provider Business Mailing Address
First Line	:	2625 ARIMO DR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-6819
Country	:	US
Telephone Number	:	702-862-4284
Fax Number	:	702-878-4284

Provider Business Practice Location Address
First Line	:	3111 S MARYLAND PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-2303
Country	:	US
Telephone Number	:	702-862-4284
Fax Number	:

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

Provider Enumeration Date	:	10/31/2009
Last Update Date	:	10/31/2009

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