Provider Demographics
NPI:1033165733
Name:RHODES, WILLIAM MAURICE (PT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MAURICE
Last Name:RHODES
Suffix:
Gender:M
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:RR 3 BOX 3266
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-9422
Mailing Address - Country:US
Mailing Address - Phone:304-788-7816
Mailing Address - Fax:304-788-7863
Practice Address - Street 1:RR 3 BOX 3266
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-9422
Practice Address - Country:US
Practice Address - Phone:304-788-7816
Practice Address - Fax:304-788-7863
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV000239225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
425339OtherMAMSI/UNITED HEALTHCARE
MD41978403OtherCAREFIRST BCBS
WV9420177000Medicaid
0899911Medicare ID - Type Unspecified