Provider Demographics
NPI:1437148053
Name:RHODES, JONATHAN P (MSPT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:P
Last Name:RHODES
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 WHISPERWOOD CV
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037
Mailing Address - Country:US
Mailing Address - Phone:801-510-0283
Mailing Address - Fax:
Practice Address - Street 1:722 SHEPARD LN
Practice Address - Street 2:SUITE 105
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-3845
Practice Address - Country:US
Practice Address - Phone:801-510-0283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2016-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2907342401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP80781Medicare UPIN