Provider Demographics
NPI:1285695817
Name:THORLEY, RODNEY ROLLINS (MD)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:ROLLINS
Last Name:THORLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14561 N OUTER 40 RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5703
Mailing Address - Country:US
Mailing Address - Phone:314-881-4006
Mailing Address - Fax:314-881-4188
Practice Address - Street 1:14561 N OUTER 40 RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:314-881-4006
Practice Address - Fax:314-881-4295
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7975208100000X
MO20020112732081P0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX219393001Medicaid
TX219393002TMedicaid
TX8CQ188OtherBCBSTX
TX219393002TMedicaid
MO152800173Medicare PIN
TX219393001Medicaid
TXTXB119757Medicare PIN