Provider Demographics
NPI:1962791806
Name:PATTON, RODNEY (QHA)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:
Last Name:PATTON
Suffix:
Gender:M
Credentials:QHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8924 SHEEP RANCH CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89143-5419
Mailing Address - Country:US
Mailing Address - Phone:702-644-4195
Mailing Address - Fax:702-644-5219
Practice Address - Street 1:8924 SHEEP RANCH CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89143-5419
Practice Address - Country:US
Practice Address - Phone:702-644-4195
Practice Address - Fax:702-644-5219
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVH1400104H113186OtherOWNER