Provider Demographics
NPI:1992486369
Name:DEADRICK, RHONDA (LMT)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:DEADRICK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2352 FOURTH ST BOX 321
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-3712
Mailing Address - Country:US
Mailing Address - Phone:928-526-4653
Mailing Address - Fax:
Practice Address - Street 1:2323 E GREENLAW LN STE 7B
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1849
Practice Address - Country:US
Practice Address - Phone:480-845-2895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-08629225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist