MEDICARE: JILL MIRKIS PTA

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	PTA0312	NV

General Provider Information

NPI Number	:	1740667377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL MIRKIS PTA

Provider Business Mailing Address
First Line	:	7205 CHIC AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-5992
Country	:	US
Telephone Number	:	702-807-3725
Fax Number	:

Provider Business Practice Location Address
First Line	:	7375 PRAIRIE FALCON RD STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0810
Country	:	US
Telephone Number	:	702-869-4401
Fax Number	:

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

Provider Enumeration Date	:	05/04/2015
Last Update Date	:	12/17/2021

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Directions to “ JILL MIRKIS PTA” Practice Location

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