MEDICARE: JESTYNE RAINA LEE SABLAN DPT

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	6728	NV

General Provider Information

NPI Number	:	1578446597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESTYNE RAINA LEE SABLAN DPT

Provider Business Mailing Address
First Line	:	8689 W CHARLESTON BLVD STE 106
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5485
Country	:	US
Telephone Number	:	702-991-6798
Fax Number	:	702-628-8367

Provider Business Practice Location Address
First Line	:	8689 W CHARLESTON BLVD STE 106
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5485
Country	:	US
Telephone Number	:	702-991-6798
Fax Number	:	702-628-8367

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

Provider Enumeration Date	:	07/28/2025
Last Update Date	:	07/28/2025

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