Provider Demographics
NPI:1386697340
Name:RHODES, ELI W (MPT)
Entity type:Individual
Prefix:MR
First Name:ELI
Middle Name:W
Last Name:RHODES
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 N TORNADO WAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-6006
Mailing Address - Country:US
Mailing Address - Phone:304-788-7816
Mailing Address - Fax:304-788-7863
Practice Address - Street 1:196 N TORNADO WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-6006
Practice Address - Country:US
Practice Address - Phone:304-788-7816
Practice Address - Fax:304-788-7863
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2131556OtherMAMSI/UNITED HEALTHCARE
WV3810003743Medicaid
WV001717160OtherMOUNTAIN STATE BCBS
MD64319601OtherCAREFIRST BCBS
4125941Medicare ID - Type Unspecified