Healthcare Provider Details

I. General information

NPI: 1962985192
Provider Name (Legal Business Name): JATHAN L RHOADS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 E WABASH ST STE 100
FRANKFORT IN
46041-9400
US

IV. Provider business mailing address

2605 N LEBANON ST
LEBANON IN
46052-1476
US

V. Phone/Fax

Practice location:
  • Phone: 765-659-7400
  • Fax: 765-659-7408
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05007767A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: