Provider Demographics
NPI:1508090317
Name:RHOADES, DELAILA M
Entity Type:Individual
Prefix:
First Name:DELAILA
Middle Name:M
Last Name:RHOADES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 W ROAD 1 N
Mailing Address - Street 2:STE A
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-5943
Mailing Address - Country:US
Mailing Address - Phone:928-636-8521
Mailing Address - Fax:928-636-8591
Practice Address - Street 1:411 W ROAD 1 N
Practice Address - Street 2:STE A
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323-5943
Practice Address - Country:US
Practice Address - Phone:928-636-8521
Practice Address - Fax:928-636-8591
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ8480OtherLICENSE 8480