Provider Demographics
NPI:1487169066
Name:RATHBUN, JOSHUA QUINTON
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:QUINTON
Last Name:RATHBUN
Suffix:
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 1:275 W NATICK RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1079
Mailing Address - Country:US
Mailing Address - Phone:401-579-2302
Mailing Address - Fax:
Practice Address - Street 1:275 W NATICK RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1079
Practice Address - Country:US
Practice Address - Phone:401-579-2302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1346589215OtherHOME CARE