Provider Demographics
NPI:1174504112
Name:YURTINUS, JESSICA LANE (MSPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LANE
Last Name:YURTINUS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:973 MICA DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89705-7255
Mailing Address - Country:US
Mailing Address - Phone:775-392-3689
Mailing Address - Fax:775-783-6191
Practice Address - Street 1:973 MICA DR
Practice Address - Street 2:SUITE 201
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89705-7255
Practice Address - Country:US
Practice Address - Phone:775-392-3689
Practice Address - Fax:775-783-6191
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP51693Medicare UPIN
NV40518Medicare ID - Type Unspecified