Provider Demographics
NPI:1578736161
Name:PATSY RHODES
Entity Type:Organization
Organization Name:PATSY RHODES
Other - Org Name:SECRETS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:G
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED CONSULTANT
Authorized Official - Phone:205-674-1626
Mailing Address - Street 1:1033 ROCKYBROOK TRAIL
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35214
Mailing Address - Country:US
Mailing Address - Phone:205-674-1626
Mailing Address - Fax:205-674-1999
Practice Address - Street 1:1033 ROCKY BROOK TRL
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35214-1001
Practice Address - Country:US
Practice Address - Phone:205-674-1626
Practice Address - Fax:205-674-1999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL08006183335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========OtherEIN #
AL=========OtherEIN #