Provider Demographics
NPI:1902363344
Name:JUMALON, ARLE TROY CENIZA (PT)
Entity Type:Individual
Prefix:
First Name:ARLE TROY
Middle Name:CENIZA
Last Name:JUMALON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4614 ERIN GLEN ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-7253
Mailing Address - Country:US
Mailing Address - Phone:702-224-4889
Mailing Address - Fax:
Practice Address - Street 1:10401 WEST CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135
Practice Address - Country:US
Practice Address - Phone:702-496-9802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2285225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist