Healthcare Provider Details

I. General information

NPI: 1164498119
Provider Name (Legal Business Name): BECKY JEAN RODDA PT, MHS, OCS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3544 MERIDIAN CROSSINGS SUITE 160
OKEMOS MI
48864-6025
US

IV. Provider business mailing address

6211 COBBLERS DR
EAST LANSING MI
48823-7829
US

V. Phone/Fax

Practice location:
  • Phone: 517-347-2495
  • Fax: 517-347-3540
Mailing address:
  • Phone: 517-333-3194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5501002266
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: