Provider Demographics
NPI:1285047134
Name:RHODES, DANNY (PTA)
Entity type:Individual
Prefix:
First Name:DANNY
Middle Name:
Last Name:RHODES
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:IL
Mailing Address - Zip Code:61931-8073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:725 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:IL
Practice Address - Zip Code:61931-8073
Practice Address - Country:US
Practice Address - Phone:217-294-3763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.006576225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant