Provider Demographics
NPI:1376935486
Name:RHODEN, COLLETTE (DPT)
Entity Type:Individual
Prefix:
First Name:COLLETTE
Middle Name:
Last Name:RHODEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2142 UTOPIA PKWY
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-4142
Mailing Address - Country:US
Mailing Address - Phone:718-819-6803
Mailing Address - Fax:
Practice Address - Street 1:12820 W PARMER LN
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7513
Practice Address - Country:US
Practice Address - Phone:347-401-4559
Practice Address - Fax:512-666-3791
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1284869225100000X
NY038296225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03248Medicare UPIN
NYQ4WFH1Medicare PIN