Healthcare Provider Details

I. General information

NPI: 1780293944
Provider Name (Legal Business Name): HEATHER NICOLE RHOADS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13385 W MCDOWELL RD
GOODYEAR AZ
85395-2631
US

IV. Provider business mailing address

14870 W ENCANTO BLVD UNIT 2072
GOODYEAR AZ
85395-6616
US

V. Phone/Fax

Practice location:
  • Phone: 623-986-5110
  • Fax:
Mailing address:
  • Phone: 623-878-9087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-013934
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: