Provider Demographics
NPI:1003211418
Name:WAKAI, RHONDA (PT)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:WAKAI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 BEAR PAWS CLUSTER
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-8660
Mailing Address - Country:US
Mailing Address - Phone:406-241-8739
Mailing Address - Fax:
Practice Address - Street 1:1940 HARVE AVE
Practice Address - Street 2:#2
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8332
Practice Address - Country:US
Practice Address - Phone:406-542-0808
Practice Address - Fax:406-542-0909
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6522251E1200X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic