Provider Demographics
NPI:1689175218
Name:MSACHI, RHODA (PTA)
Entity Type:Individual
Prefix:
First Name:RHODA
Middle Name:
Last Name:MSACHI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 JEFFREY LN
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-7706
Mailing Address - Country:US
Mailing Address - Phone:269-240-4744
Mailing Address - Fax:
Practice Address - Street 1:4368 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-9595
Practice Address - Country:US
Practice Address - Phone:269-983-6501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502000807225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5502000807OtherDEPARTMENT OF LICENSING AND REGULATORY AFFAIRS