Kevin Jan Illastron

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

A-1092 Issued in NV

Practice address

11005 Jordyn Hill St
Las Vegas, NV 89141-6189

Phone

(650) 440-8323

NPI assigned

Jul 3, 2023

Last updated

Jul 3, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1688342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688342400000",
    "number": "1477230332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11005 JORDYN HILL ST",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891416189",
            "telephone_number": "650-440-8323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11005 JORDYN HILL ST",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891416189",
            "telephone_number": "650-440-8323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILLASTRON",
        "first_name": "KEVIN JAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-03",
        "last_updated": "2023-07-03",
        "certification_date": "2023-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NV",
            "license": "A-1092",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Iliad and Odyssey Behavioral Health LLC (Iliad and Odyssey Behavioral Health)
• Iliad and Odyssey Behavioral Health LLC (Iliad and Odyssey Behavioral Health)
• Iliad and Odyssey Behavioral Health LLC (Iliad & Odyssey Behavioral Health)
• Mariella Ilkiaeiv
• Maylin Illas Rodriguez
• Hima B. Illindala, MD
• Illuminated Path LLC
• Illuminations Counseling, LLC
• Illuminations Counseling, LLC (True Care Treatment Centers)
• Illumine Health

• Physical Therapy Assistant in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Physical Therapy Assistant in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.