Provider Demographics
NPI:1568692077
Name:MACFADZEN, RHONDA SIKES (LMT)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:SIKES
Last Name:MACFADZEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 W SAPPHIRE
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-6061
Mailing Address - Country:US
Mailing Address - Phone:435-467-3136
Mailing Address - Fax:
Practice Address - Street 1:334 W TABERNACLE ST STE J1
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3392
Practice Address - Country:US
Practice Address - Phone:435-467-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6781594701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist