Provider Demographics
NPI:1285381228
Name:SEAGEARS, JERMAINE R
Entity type:Individual
Prefix:
First Name:JERMAINE
Middle Name:R
Last Name:SEAGEARS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6545 S FORT APACHE RD STE 135-155
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-6752
Mailing Address - Country:US
Mailing Address - Phone:240-839-8003
Mailing Address - Fax:
Practice Address - Street 1:450 S BUFFALO DR STE 111
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-4442
Practice Address - Country:US
Practice Address - Phone:240-839-8003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV201914173892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer