Provider Demographics
NPI:1245665298
Name:VYKOUKAL, JAYDEE MARIE (PT)
Entity type:Individual
Prefix:
First Name:JAYDEE
Middle Name:MARIE
Last Name:VYKOUKAL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JAYDEE
Other - Middle Name:MARIE
Other - Last Name:HUPPERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6630 S MCCARRAN BLVD
Mailing Address - Street 2:STE A 4
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6145
Mailing Address - Country:US
Mailing Address - Phone:775-828-2873
Mailing Address - Fax:775-448-9405
Practice Address - Street 1:6630 S MCCARRAN BLVD
Practice Address - Street 2:STE A 4
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6145
Practice Address - Country:US
Practice Address - Phone:775-828-2873
Practice Address - Fax:775-448-9405
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV28682251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic