Provider Demographics
NPI:1669822698
Name:JAUCIAN, EDWARD BARRO (PT)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:BARRO
Last Name:JAUCIAN
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 1:2550 NATURE PARK DR STE 250
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-3206
Mailing Address - Country:US
Mailing Address - Phone:702-859-4710
Mailing Address - Fax:317-388-0805
Practice Address - Street 1:2550 NATURE PARK DR STE 250
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-3206
Practice Address - Country:US
Practice Address - Phone:702-859-9710
Practice Address - Fax:702-859-4711
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-00020890225100000X
NV4413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist