Provider Demographics
NPI:1356388797
Name:RHODES, BRANT DEWAYNE
Entity type:Individual
Prefix:
First Name:BRANT
Middle Name:DEWAYNE
Last Name:RHODES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 BABCOCK RD
Mailing Address - Street 2:710
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-6028
Mailing Address - Country:US
Mailing Address - Phone:210-396-5270
Mailing Address - Fax:210-396-5271
Practice Address - Street 1:2829 BABCOCK RD
Practice Address - Street 2:710
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6028
Practice Address - Country:US
Practice Address - Phone:210-396-5270
Practice Address - Fax:210-396-5271
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106476225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T2786OtherBLUE CROSS BLUE SHIELD TX
TX5943709OtherAETNA
TX2999829OtherCIGNA
TX8C2702Medicare PIN
TX2999829OtherCIGNA