Provider Demographics
NPI:1750325908
Name:BROWNELL, RODNEY CREEDAN (PT)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:CREEDAN
Last Name:BROWNELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 W US HIGHWAY 54
Mailing Address - Street 2:STE 103
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-6942
Mailing Address - Country:US
Mailing Address - Phone:573-317-0111
Mailing Address - Fax:
Practice Address - Street 1:396 W US HIGHWAY 54
Practice Address - Street 2:STE 103
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-6942
Practice Address - Country:US
Practice Address - Phone:573-317-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO48547500Medicaid
MO990001779Medicare ID - Type Unspecified