MEDICARE: JOHN JANATSCH

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1427332618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN JANATSCH

Provider Business Mailing Address
First Line	:	9120 BALCONY TRELLIS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-0461
Country	:	US
Telephone Number	:	702-285-8810
Fax Number	:

Provider Business Practice Location Address
First Line	:	9120 BALCONY TRELLIS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-0461
Country	:	US
Telephone Number	:	702-285-8810
Fax Number	:

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

Provider Enumeration Date	:	10/05/2011
Last Update Date	:	10/05/2011

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