Active NPI
Jennifer A Mogavero, PT
- Physical Therapist
- Las Vegas, NV
National Provider Identifier
1669655205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1256
- Practice address
- 3228 Ivory Coast Dr
Las Vegas, NV 89117-2269 - Phone
- (702) 236-9454
- NPI assigned
- Dec 5, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1256 | NV | Primary |
| Physical Therapist | 225100000X | 8861 | CO | |
| Physical Therapist | 225100000X | 016958-1 | NY |
Addresses
Primary practice location
3228 Ivory Coast Dr
Las Vegas, NV 89117-2269
Mailing address
3228 Ivory Coast Dr
Las Vegas, NV 89117-2269
Phone (702) 236-9454
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 |
|---|---|---|---|
| 8861 | CO | MD | Dentist |
| 016958-1 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196812800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1243296000000",
"number": "1669655205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3228 IVORY COAST DR",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891172269",
"telephone_number": "702-236-9454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3228 IVORY COAST DR",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891172269",
"telephone_number": "702-236-9454"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOGAVERO",
"first_name": "JENNIFER",
"middle_name": "A",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-12-05",
"last_updated": "2009-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NV",
"license": "1256",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CO",
"license": "8861",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "016958-1",
"primary": false
}
],
"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 May 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.