Provider Demographics
NPI:1376639450
Name:SMITH, RHONDA JEANE
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:JEANE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 N HARLEM AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1271
Mailing Address - Country:US
Mailing Address - Phone:708-848-4020
Mailing Address - Fax:
Practice Address - Street 1:1441 N HARLEM AVE UNIT C
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1271
Practice Address - Country:US
Practice Address - Phone:708-848-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist