Provider Demographics
NPI:1245505304
Name:MCCONOMY, RHONDA EVELYN (CMT)
Entity type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:EVELYN
Last Name:MCCONOMY
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ENERGY DR
Mailing Address - Street 2:#2
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-6267
Mailing Address - Country:US
Mailing Address - Phone:208-569-3591
Mailing Address - Fax:
Practice Address - Street 1:482 CONSTITUTION WAY
Practice Address - Street 2:B4
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3565
Practice Address - Country:US
Practice Address - Phone:208-569-3591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist