Provider Demographics
NPI:1770837171
Name:RHODES, RHONDA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:
Last Name:RHODES
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 1:1308 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-2228
Mailing Address - Country:US
Mailing Address - Phone:618-529-2922
Mailing Address - Fax:618-529-0102
Practice Address - Street 1:1308 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-2228
Practice Address - Country:US
Practice Address - Phone:618-529-2922
Practice Address - Fax:618-529-0102
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.002553225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant