Provider Demographics
NPI:1477098572
Name:RHODES, RICHARD C (CMT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:C
Last Name:RHODES
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2618 HILL PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-1734
Mailing Address - Country:US
Mailing Address - Phone:408-269-2909
Mailing Address - Fax:
Practice Address - Street 1:2618 HILL PARK DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-1734
Practice Address - Country:US
Practice Address - Phone:408-269-2909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-27
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAMTC 67448225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist