Healthcare Provider Details

I. General information

NPI: 1386911022
Provider Name (Legal Business Name): MORGAN RHODEWALT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 N MAIN ST
FLORENCE MA
01062-1287
US

IV. Provider business mailing address

111 FEDERAL ST
GREENFIELD MA
01301-2501
US

V. Phone/Fax

Practice location:
  • Phone: 413-586-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: