Provider Demographics
NPI:1568714293
Name:DUROST, RODNEY HAROLD JR (LMT)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:HAROLD
Last Name:DUROST
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5027 ANTOINE PL
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-3469
Mailing Address - Country:US
Mailing Address - Phone:850-217-9336
Mailing Address - Fax:
Practice Address - Street 1:5027 ANTOINE PL
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-3469
Practice Address - Country:US
Practice Address - Phone:850-217-9336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2456225700000X
FLMA38623225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC2627OtherBLUECROSS BLUESHIELD