Provider Demographics
NPI:1770129645
Name:DOUGLAS, RHONDA LEONORA
Entity type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:LEONORA
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:RHONDA
Other - Middle Name:LEONORA
Other - Last Name:LARKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:42 4 SEASONSSHOPPING CTR STE 111
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3197
Mailing Address - Country:US
Mailing Address - Phone:314-682-6555
Mailing Address - Fax:
Practice Address - Street 1:42 4 SEASONSSHOPPING CTR STE 111
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3197
Practice Address - Country:US
Practice Address - Phone:314-682-6555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006008068225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty