MEDICARE: JAMES READENCE

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	225200000X	Physical Therapy Assistant	A-0136	NV

General Provider Information

NPI Number	:	1558615294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES READENCE

Provider Business Mailing Address
First Line	:	7100 W ALEXANDER RD
Second Line	:	#2006
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6596
Country	:	US
Telephone Number	:	702-289-7068
Fax Number	:

Provider Business Practice Location Address
First Line	:	7100 W ALEXANDER RD
Second Line	:	#2006
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6596
Country	:	US
Telephone Number	:	702-289-7068
Fax Number	:

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

Provider Enumeration Date	:	11/02/2012
Last Update Date	:	11/02/2012

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