Healthcare Provider Details

I. General information

NPI: 1801142344
Provider Name (Legal Business Name): JADE MADISON THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5375 PENDINI POINT CT
LAS VEGAS NV
89141-0419
US

IV. Provider business mailing address

5375 PENDINI POINT CT
LAS VEGAS NV
89141-0419
US

V. Phone/Fax

Practice location:
  • Phone: 702-499-0443
  • Fax:
Mailing address:
  • Phone: 702-499-0443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JADE MADISON
Title or Position: OWNER
Credential: OTR/L
Phone: 702-499-0994