Healthcare Provider Details

I. General information

NPI: 1821367087
Provider Name (Legal Business Name): RODNEY BUMPERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2011
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3016 W CHARLESTON BLVD STE 150
LAS VEGAS NV
89102-1964
US

IV. Provider business mailing address

1504 BLACKCOMBE ST UNIT 204
LAS VEGAS NV
89128-8019
US

V. Phone/Fax

Practice location:
  • Phone: 404-849-9918
  • Fax:
Mailing address:
  • Phone: 404-849-9918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: