Provider Demographics
NPI:1356236400
Name:KISSMAN, JACOB PAUL (PT, DPT, CSCS)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:PAUL
Last Name:KISSMAN
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 BABYLON MILL ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-3655
Mailing Address - Country:US
Mailing Address - Phone:702-789-9592
Mailing Address - Fax:
Practice Address - Street 1:6170 N DURANGO DR STE 160
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-3949
Practice Address - Country:US
Practice Address - Phone:702-222-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6738261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy