Provider Demographics
NPI:1467421834
Name:HAAS, JEREMY BRENT (MS, ATC/LAT, CSCS)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:BRENT
Last Name:HAAS
Suffix:
Gender:M
Credentials:MS, ATC/LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 AMERICAN PACIFIC DR
Mailing Address - Street 2:APT 1124
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-8790
Mailing Address - Country:US
Mailing Address - Phone:702-875-1256
Mailing Address - Fax:
Practice Address - Street 1:6480 W FLAMINGO RD
Practice Address - Street 2:SUITE B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-7128
Practice Address - Country:US
Practice Address - Phone:702-251-9009
Practice Address - Fax:702-251-9003
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05061012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer