Provider Demographics
NPI:1376782979
Name:RHOADS, THERESA LEE
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:LEE
Last Name:RHOADS
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 1:4987 HIGHWAY 89 S
Mailing Address - Street 2:
Mailing Address - City:BELLE
Mailing Address - State:MO
Mailing Address - Zip Code:65013-3035
Mailing Address - Country:US
Mailing Address - Phone:573-859-6688
Mailing Address - Fax:
Practice Address - Street 1:100 B WEST THIRD STREET
Practice Address - Street 2:
Practice Address - City:BELLE
Practice Address - State:MO
Practice Address - Zip Code:65013
Practice Address - Country:US
Practice Address - Phone:573-859-6688
Practice Address - Fax:573-859-6655
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC0921916372500000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No372500000XNursing Service Related ProvidersChore Provider