Provider Demographics
NPI:1710247697
Name:STUCKEY, CURTIS DYLAN JR
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:DYLAN
Last Name:STUCKEY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 W ANN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-3839
Mailing Address - Country:US
Mailing Address - Phone:702-539-2200
Mailing Address - Fax:
Practice Address - Street 1:3920 W ANN RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-3839
Practice Address - Country:US
Practice Address - Phone:702-539-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner