Provider Demographics
NPI:1386294973
Name:LEWIS, JESSICA MARIE (DPT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:LEWIS
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 LA SCONSA DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-7562
Mailing Address - Country:US
Mailing Address - Phone:702-526-5550
Mailing Address - Fax:702-347-7649
Practice Address - Street 1:850 LA SCONSA DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-7562
Practice Address - Country:US
Practice Address - Phone:702-526-5550
Practice Address - Fax:702-347-7649
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4077OtherST OF NEVADA PHYSICAL THERAPY LICENSE