Provider Demographics
NPI:1629468012
Name:BURT, RODNEY
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:
Last Name:BURT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 CAPITAL CIR NE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-8406
Mailing Address - Country:US
Mailing Address - Phone:850-408-9756
Mailing Address - Fax:850-597-7138
Practice Address - Street 1:1832 CAPITAL CIR NE
Practice Address - Street 2:SUITE 2
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-8406
Practice Address - Country:US
Practice Address - Phone:850-408-9756
Practice Address - Fax:850-597-7138
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL232974253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care