Provider Demographics
NPI:1740551837
Name:RODNEY, ANTJE MARIANNE (PT)
Entity type:Individual
Prefix:MRS
First Name:ANTJE
Middle Name:MARIANNE
Last Name:RODNEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 POWELL BLVD APT 3204
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-7160
Mailing Address - Country:US
Mailing Address - Phone:313-917-5756
Mailing Address - Fax:
Practice Address - Street 1:107 POWELL BLVD APT 3204
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-7160
Practice Address - Country:US
Practice Address - Phone:313-917-5756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004439225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist