Healthcare Provider Details

I. General information

NPI: 1558202333
Provider Name (Legal Business Name): ELIZABETH ANN RHODES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W GRACE ST
RICHMOND VA
23230-3800
US

IV. Provider business mailing address

5855 BREMO RD
RICHMOND VA
23226-1930
US

V. Phone/Fax

Practice location:
  • Phone: 804-780-6028
  • Fax:
Mailing address:
  • Phone: 804-285-2011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126003812
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: