Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 3483-024 | WI |
N | 2251E1200X | Ergonomics | 3483-024 | WI |
N | 225XE1200X | Ergonomics | 3483-024 | WI |
N | 2251G0304X | Physical Therapist - Geriatrics | 3483-024 | WI |
N | 2251X0800X | Physical Therapist - Orthopedic | 3483-024 | WI |
NPI | 1649490152 |
---|---|
Provider Name | Mr. Robert Clark Rhodes |
First Address | Oshkosh, WI 54904-8860 |
Second Address | Oshkosh, WI 54904-6710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40181400 | (05) | WI |