=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053401133
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENNIS W RHOADES D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 757 JOHNSONBURG RD GROUND FLOOR REHAB BUILDING
-----------------------------------------------------
City | SAINT MARYS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15857-3488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-834-6300
-----------------------------------------------------
Fax | 814-781-1321
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 757 JOHNSONBURG RD GROUND FLOOR REHAB BUILDING
-----------------------------------------------------
City | SAINT MARYS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15857-3488
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-834-6300
-----------------------------------------------------
Fax | 814-781-1321
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS-005083-L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------