Provider Demographics
NPI:1306139027
Name:RHODES, NICHOLAS R (LMT)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:R
Last Name:RHODES
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:MO
Mailing Address - Zip Code:63555-1054
Mailing Address - Country:US
Mailing Address - Phone:660-465-2631
Mailing Address - Fax:
Practice Address - Street 1:429 W MADISON ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:MO
Practice Address - Zip Code:63555-1054
Practice Address - Country:US
Practice Address - Phone:660-465-2631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006007834225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist