Provider Demographics
NPI:1366772972
Name:YUAG, JASON E (PT)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:E
Last Name:YUAG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 NATURE PARK DR STE 250
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-3206
Mailing Address - Country:US
Mailing Address - Phone:702-859-4710
Mailing Address - Fax:
Practice Address - Street 1:2550 NATURE PARK DR STE 250
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-3206
Practice Address - Country:US
Practice Address - Phone:702-859-4710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36382225100000X
NV4046225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPENDINGOtherMEDICARE PTAN