Provider Demographics
NPI:1578816096
Name:RODMAN, ANDREW DAVID (PTA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:DAVID
Last Name:RODMAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32280 RAILROAD HWY
Mailing Address - Street 2:
Mailing Address - City:NEOLA
Mailing Address - State:IA
Mailing Address - Zip Code:51559-5530
Mailing Address - Country:US
Mailing Address - Phone:712-898-0074
Mailing Address - Fax:
Practice Address - Street 1:1010 LONGVIEW RD
Practice Address - Street 2:
Practice Address - City:MISSOURI VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51555-1227
Practice Address - Country:US
Practice Address - Phone:712-898-0074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001309225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant