Provider Demographics
NPI:1154802825
Name:RHODES, LISA (DPM)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:RHODES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 SWAMP RD STE 203
Mailing Address - Street 2:
Mailing Address - City:FOUNTAINVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18923-9656
Mailing Address - Country:US
Mailing Address - Phone:215-230-4600
Mailing Address - Fax:215-230-8404
Practice Address - Street 1:5055 SWAMP RD STE 203
Practice Address - Street 2:
Practice Address - City:FOUNTAINVILLE
Practice Address - State:PA
Practice Address - Zip Code:18923-9656
Practice Address - Country:US
Practice Address - Phone:215-230-4600
Practice Address - Fax:215-230-8404
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC00046213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist