Individual
KEVIN JAN ILLASTRON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11005 JORDYN HILL ST, LAS VEGAS, NV 89141-6189
(650) 440-8323
Mailing address
11005 JORDYN HILL ST, LAS VEGAS, NV 89141-6189
(650) 440-8323
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A-1092
NV
Other
Enumeration date
07/03/2023
Last updated
07/03/2023
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