Active NPI
Jessica Marie Lewis, DPT
- Physical Therapist
- Las Vegas, NV
National Provider Identifier
1386294973
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4077
- Practice address
- 850 La Sconsa Dr
Las Vegas, NV 89138-7562 - Phone
- (702) 526-5550
- Fax
- (702) 347-7649
- NPI assigned
- Sep 16, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 | 4077 | NV | Primary |
Addresses
Primary practice location
850 La Sconsa Dr
Las Vegas, NV 89138-7562
Mailing address
850 La Sconsa Dr
Las Vegas, NV 89138-7562
Phone (702) 526-5550
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4077 | Other | NV | ST OF NEVADA PHYSICAL THERAPY LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4077 | NV | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Executive Fitness Inc | Single Specialty | Current | Accepting new patients |
| Good Life Therapy, LLC | Physical Therapist | Current | Accepting new patients |
| Children'S Bone and Spine Surgery, LLP | Single Specialty | Past | Accepting new patients |
| Executive Fitness Inc | Single Specialty | Past | Accepting new patients |
Locations
2779 W Horizon Ridge Pkwy
Ste 100
Henderson, NV 89052
Phone (702) 222-1000
6440 Medical Center St
Ste 100
Las Vegas, NV 89148
Phone (702) 222-1000
Organizations & group practices 4
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1743033600000",
"number": "1386294973",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "850 LA SCONSA DR",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891387562",
"telephone_number": "702-526-5550",
"fax_number": "702-347-7649"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "850 LA SCONSA DR",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891387562",
"telephone_number": "702-526-5550",
"fax_number": "702-347-7649"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEWIS",
"first_name": "JESSICA",
"middle_name": "MARIE",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-09-16",
"last_updated": "2025-03-27",
"certification_date": "2025-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": "NV",
"license": "4077",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ST OF NEVADA PHYSICAL THERAPY LICENSE",
"identifier": "4077",
"state": "NV"
}
],
"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 Mar 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.