Provider Demographics
NPI:1194714667
Name:RHODES, SARAH R (MS, LAT, ATC)
Entity type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:R
Last Name:RHODES
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1567 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:NAPPANEE
Mailing Address - State:IN
Mailing Address - Zip Code:46550-2805
Mailing Address - Country:US
Mailing Address - Phone:574-361-4108
Mailing Address - Fax:
Practice Address - Street 1:1001 MCKINLEY AVE.
Practice Address - Street 2:DEPARTMENT OF ATHLETICS
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46565
Practice Address - Country:US
Practice Address - Phone:574-257-2677
Practice Address - Fax:574-257-3385
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001026A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer