Provider Demographics
NPI:1952319824
Name:PEARSON, RHONDA L (PT)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:L
Last Name:PEARSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:L
Other - Last Name:OMIT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:W3024 BEAR TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:IRMA
Mailing Address - State:WI
Mailing Address - Zip Code:54442-9737
Mailing Address - Country:US
Mailing Address - Phone:715-219-2286
Mailing Address - Fax:
Practice Address - Street 1:2555 PHILLIPS FIELD RD STE 202
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3933
Practice Address - Country:US
Practice Address - Phone:907-456-5990
Practice Address - Fax:907-374-2036
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9607024225100000X
AK123669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI76226OtherSECURITY HEALTH PLAN
WI40355100Medicaid
WI002223040Medicare ID - Type Unspecified