MEDICARE: JESSI JAECH

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-1446	NV

General Provider Information

NPI Number	:	1114770443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSI JAECH

Provider Business Mailing Address
First Line	:	9983 SWIMMING HOLE ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7159
Country	:	US
Telephone Number	:	951-591-3360
Fax Number	:

Provider Business Practice Location Address
First Line	:	4640 W SUNSET
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118
Country	:	US
Telephone Number	:	951-591-3360
Fax Number	:

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

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	04/08/2024

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Directions to “ JESSI JAECH ” Practice Location

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