Provider Demographics
NPI:1710923917
Name:LEAVITT, JEFFREY PAUL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:PAUL
Last Name:LEAVITT
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3037 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4190
Mailing Address - Country:US
Mailing Address - Phone:702-263-4993
Mailing Address - Fax:702-263-8646
Practice Address - Street 1:3037 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4190
Practice Address - Country:US
Practice Address - Phone:702-263-4993
Practice Address - Fax:702-263-8646
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV102142Medicare ID - Type Unspecified