Provider Demographics
NPI:1063405462
Name:GOBLE, RODNEY P (MPT)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:P
Last Name:GOBLE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 WINANS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-8223
Mailing Address - Country:US
Mailing Address - Phone:810-772-9062
Mailing Address - Fax:
Practice Address - Street 1:9299 GOBLE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-8700
Practice Address - Country:US
Practice Address - Phone:810-772-9062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010295225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650D757050OtherBCBS
MI0N16540Medicare ID - Type Unspecified