Provider Demographics
NPI:1588895387
Name:RHODEBACK, JOHN ROBERT
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:RHODEBACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11474 PINHOOK RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23146-1507
Mailing Address - Country:US
Mailing Address - Phone:804-749-8628
Mailing Address - Fax:804-749-8425
Practice Address - Street 1:11474 PINHOOK RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:VA
Practice Address - Zip Code:23146-1507
Practice Address - Country:US
Practice Address - Phone:804-749-8628
Practice Address - Fax:804-749-8425
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2705026348171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications