Provider Demographics
NPI:1336012392
Name:NAVERA, JEAN-LUC O (PTA)
Entity type:Individual
Prefix:
First Name:JEAN-LUC
Middle Name:O
Last Name:NAVERA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 W HORIZON RIDGE PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5030
Mailing Address - Country:US
Mailing Address - Phone:702-840-2500
Mailing Address - Fax:725-234-1515
Practice Address - Street 1:3005 W HORIZON RIDGE PKWY STE 101
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5030
Practice Address - Country:US
Practice Address - Phone:702-840-2500
Practice Address - Fax:725-234-1515
Is Sole Proprietor?:No
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-1346225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant