Provider Demographics
NPI:1841766888
Name:RHODENBAUGH, RICHARD II (PTA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:RHODENBAUGH
Suffix:II
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E SPRING ST APT D12
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-4532
Mailing Address - Country:US
Mailing Address - Phone:812-821-5738
Mailing Address - Fax:
Practice Address - Street 1:318 BILBREY ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-1706
Practice Address - Country:US
Practice Address - Phone:931-823-6403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6987225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant