Provider Demographics
NPI:1194956201
Name:TIU, JAYROLD C (PT)
Entity type:Individual
Prefix:MR
First Name:JAYROLD
Middle Name:C
Last Name:TIU
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:P. O. BOX 777851
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89077-7851
Mailing Address - Country:US
Mailing Address - Phone:314-484-9368
Mailing Address - Fax:
Practice Address - Street 1:7250 PEAK DR.
Practice Address - Street 2:SUITE #118
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:702-846-2100
Practice Address - Fax:702-665-5170
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist