Provider Demographics
NPI:1851627582
Name:MIKLAS, JACALYN L (PT)
Entity Type:Individual
Prefix:MS
First Name:JACALYN
Middle Name:L
Last Name:MIKLAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JACALYN
Other - Middle Name:
Other - Last Name:LEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2625 ARIMO DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-6819
Mailing Address - Country:US
Mailing Address - Phone:702-862-4284
Mailing Address - Fax:702-878-4284
Practice Address - Street 1:3111 S MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2303
Practice Address - Country:US
Practice Address - Phone:702-862-4284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-31
Last Update Date:2009-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist