Provider Demographics
NPI:1518051291
Name:DEETS, JEFFREY LYNN (PT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LYNN
Last Name:DEETS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:68 N PECOS RD
Mailing Address - Street 2:STE B
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7340
Mailing Address - Country:US
Mailing Address - Phone:702-597-8999
Mailing Address - Fax:702-597-8988
Practice Address - Street 1:2800 E DESERT INN RD
Practice Address - Street 2:200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121
Practice Address - Country:US
Practice Address - Phone:702-892-9077
Practice Address - Fax:702-892-9044
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV05702251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003402061Medicaid