Provider Demographics
NPI:1942868724
Name:MAWAE, JONAH KALEIAHI (DPT)
Entity Type:Individual
Prefix:
First Name:JONAH
Middle Name:KALEIAHI
Last Name:MAWAE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7425 W AZURE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-4418
Mailing Address - Country:US
Mailing Address - Phone:702-515-4009
Mailing Address - Fax:
Practice Address - Street 1:7425 W AZURE DR STE 140
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-4425
Practice Address - Country:US
Practice Address - Phone:702-515-4009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV40192251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics