Provider Demographics
NPI:1417591843
Name:RICE, BRODIE
Entity Type:Individual
Prefix:
First Name:BRODIE
Middle Name:
Last Name:RICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 S DOUGLAS HWY STE 130
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5400
Mailing Address - Country:US
Mailing Address - Phone:307-696-8016
Mailing Address - Fax:307-206-8104
Practice Address - Street 1:2007 S DOUGLAS HWY STE 130
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5400
Practice Address - Country:US
Practice Address - Phone:307-696-8016
Practice Address - Fax:307-206-8104
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYCPO04185222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist