Provider Demographics
NPI:1528045010
Name:HYNES, RHONDA KAY (PT)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:KAY
Last Name:HYNES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:PHONDA
Other - Middle Name:KAY
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2865 NW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3516
Mailing Address - Country:US
Mailing Address - Phone:541-752-0083
Mailing Address - Fax:541-752-9624
Practice Address - Street 1:2865 NW 29TH ST
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3516
Practice Address - Country:US
Practice Address - Phone:541-752-0083
Practice Address - Fax:541-752-9624
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1866225100000X
ID102225100000X
UT741064032401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR071808Medicaid
OR116541Medicare PIN