Provider Demographics
NPI:1225351935
Name:DEYOUNG, RHIANNON MARIE (PT)
Entity Type:Individual
Prefix:MISS
First Name:RHIANNON
Middle Name:MARIE
Last Name:DEYOUNG
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 1:8450 ALGOMA AVE NE STE AAA
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-7508
Mailing Address - Country:US
Mailing Address - Phone:616-893-9731
Mailing Address - Fax:616-893-9831
Practice Address - Street 1:8450 ALGOMA AVE NE STE AAA
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-7508
Practice Address - Country:US
Practice Address - Phone:616-893-9731
Practice Address - Fax:616-893-9831
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014896174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist