Provider Demographics
NPI:1295290724
Name:RHODES, MADISON (PT)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:RHODES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:19325 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-3557
Mailing Address - Country:US
Mailing Address - Phone:818-885-6200
Mailing Address - Fax:818-885-6228
Practice Address - Street 1:19325 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-3557
Practice Address - Country:US
Practice Address - Phone:818-885-6200
Practice Address - Fax:818-885-6228
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA295841OtherSTATE LICENSE