Active NPI
Jason A Derryberry, MSPT
- Physical Therapist
- Las Vegas, NV
National Provider Identifier
1164469367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1512
- Practice address
- 911 North Buffalo Dr
Ste 107
Las Vegas, NV 89128-0380 - Phone
- (702) 255-7223
- Fax
- (702) 255-6211
- NPI assigned
- May 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1512 | NV | Primary |
Addresses
Primary practice location
911 North Buffalo Dr
Ste 107
Las Vegas, NV 89128-0380
Mailing address
911 North Buffalo Dr
Ste 107
Las Vegas, NV 89128-0380
Phone (702) 255-7223
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1512 | NV | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pace Physical Therapy & Spine Fitness | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Las Vegas, NV
- NPI 1114972973
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1164469367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "911 NORTH BUFFALO DR",
"address_2": "STE 107",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891280380",
"telephone_number": "702-255-7223",
"fax_number": "702-255-6211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "911 NORTH BUFFALO DR",
"address_2": "STE 107",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891280380",
"telephone_number": "702-255-7223",
"fax_number": "702-255-6211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERRYBERRY",
"first_name": "JASON",
"middle_name": "A",
"credential": "MSPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-31",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NV",
"license": "1512",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.