Healthcare Provider Details

I. General information

NPI: 1023444361
Provider Name (Legal Business Name): JAY J RHODES L.O.F.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 12/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 CAPE CORAL PKWY E SUITE 1
CAPE CORAL FL
33904-7515
US

IV. Provider business mailing address

4706 CHIQUITA BLVD S # 200 PMB 408
CAPE CORAL FL
33914-6321
US

V. Phone/Fax

Practice location:
  • Phone: 239-541-9480
  • Fax: 888-537-3611
Mailing address:
  • Phone: 239-541-9480
  • Fax: 888-537-3611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberORF119
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: