Provider Demographics
NPI:1598367591
Name:RODENBOSTEL, DANA LYNN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:LYNN
Last Name:RODENBOSTEL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2186 E CRESCENT PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-3245
Mailing Address - Country:US
Mailing Address - Phone:480-251-9691
Mailing Address - Fax:
Practice Address - Street 1:5850 E STILL CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3618
Practice Address - Country:US
Practice Address - Phone:480-219-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31421208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation