Provider Demographics
NPI:1508219387
Name:JONES, JESSE JAY (LMT)
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:JAY
Last Name:JONES
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3324 VENTANA HILLS DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-0201
Mailing Address - Country:US
Mailing Address - Phone:702-408-8479
Mailing Address - Fax:
Practice Address - Street 1:8751 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5480
Practice Address - Country:US
Practice Address - Phone:702-408-8479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.5419225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist