Provider Demographics
NPI:1467437426
Name:RATHBONE, ROGER KEITH (PT DPT)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:KEITH
Last Name:RATHBONE
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:16644 MOUNTAIN RD
Mailing Address - City:MONTPELIER
Mailing Address - State:VA
Mailing Address - Zip Code:23192-0369
Mailing Address - Country:US
Mailing Address - Phone:804-883-3005
Mailing Address - Fax:804-883-3006
Practice Address - Street 1:16644 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VA
Practice Address - Zip Code:23192-2600
Practice Address - Country:US
Practice Address - Phone:804-883-3005
Practice Address - Fax:804-883-3006
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
426163OtherALLIANCE PPO LLC
5318282OtherAETNA
P00175805OtherPALMETTO GBA
6400902OtherUNITED HEALTHCARE
00V829K76OtherMEDICARE
102450OtherANTHEM
541669371OtherTRICARE NORTH REGION
426163OtherOPTIMUM CHOICE
426163OtherALLIANCE PPO LLC