MEDICARE: JENIFER KRISTINE CORDOVA 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	4604	NV
2	225100000X	Physical Therapist	PT39340	CA

General Provider Information

NPI Number	:	1760731061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENIFER KRISTINE CORDOVA DPT

Provider Business Mailing Address
First Line	:	7121 W CRAIG RD STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6023
Country	:	US
Telephone Number	:	725-726-7847
Fax Number	:

Provider Business Practice Location Address
First Line	:	7121 W CRAIG RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6001
Country	:	US
Telephone Number	:	725-726-7847
Fax Number	:

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

Provider Enumeration Date	:	08/31/2012
Last Update Date	:	09/05/2024

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Directions to “ JENIFER KRISTINE CORDOVA DPT” Practice Location

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