Provider Demographics
NPI:1679825251
Name:RHOADES, SUSAN M (DPT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:RHOADES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7910 WYOMING BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6029
Mailing Address - Country:US
Mailing Address - Phone:505-727-4882
Mailing Address - Fax:505-727-9333
Practice Address - Street 1:7910 WYOMING BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6029
Practice Address - Country:US
Practice Address - Phone:505-727-4882
Practice Address - Fax:505-727-9333
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1222225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM81843OtherLOVELACE EMPLOYEE NUMBER