MEDICARE: ARLE TROY CENIZA JUMALON PT

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	2285	NV

General Provider Information

NPI Number	:	1902363344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARLE TROY CENIZA JUMALON PT

Provider Business Mailing Address
First Line	:	4614 ERIN GLEN ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7253
Country	:	US
Telephone Number	:	702-224-4889
Fax Number	:

Provider Business Practice Location Address
First Line	:	10401 WEST CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135
Country	:	US
Telephone Number	:	702-496-9802
Fax Number	:

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

Provider Enumeration Date	:	02/21/2019
Last Update Date	:	02/21/2019

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