Provider Demographics
NPI:1881787695
Name:HENNE, JASON T (PT)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:T
Last Name:HENNE
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 1:6856 SCARLET FLAX ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4830
Mailing Address - Country:US
Mailing Address - Phone:702-281-9265
Mailing Address - Fax:702-446-5149
Practice Address - Street 1:6856 SCARLET FLAX ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4830
Practice Address - Country:US
Practice Address - Phone:702-281-9265
Practice Address - Fax:702-446-5149
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1945225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100301Medicare ID - Type Unspecified