MEDICARE: JOSHUA RUCKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1790212553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA RUCKER

Provider Business Mailing Address
First Line	:	807 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-3933
Country	:	US
Telephone Number	:	702-750-9387
Fax Number	:	702-790-2570

Provider Business Practice Location Address
First Line	:	807 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-3933
Country	:	US
Telephone Number	:	702-750-9387
Fax Number	:	702-790-2570

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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Directions to “ JOSHUA RUCKER ” Practice Location

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