Provider Demographics
NPI:1962800219
Name:RHODES, KIM G (PTA)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:G
Last Name:RHODES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7223 MAUMEE WESTERN RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9755
Mailing Address - Country:US
Mailing Address - Phone:419-270-2171
Mailing Address - Fax:
Practice Address - Street 1:219 PAGE ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43620-1430
Practice Address - Country:US
Practice Address - Phone:419-865-7487
Practice Address - Fax:419-865-8360
Is Sole Proprietor?:No
Enumeration Date:2014-12-18
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA003096225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant