Healthcare Provider Details

I. General information

NPI: 1366362303
Provider Name (Legal Business Name): JARET TIETJEN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W PIONEER BLVD
MESQUITE NV
89027-8864
US

IV. Provider business mailing address

1140 W PIONEER BLVD
MESQUITE NV
89027-8864
US

V. Phone/Fax

Practice location:
  • Phone: 702-346-1899
  • Fax: 702-346-8581
Mailing address:
  • Phone: 702-346-1899
  • Fax: 702-346-8581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6997
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: