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General NPI Number Information
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NPI Number | 1568138329
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Entity Type | Individual
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Provider Name | KANDACE RODATZ LMT
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Gender | Female
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Dates
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Enumeration Date | 08/20/2021
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Last Update Date | 08/20/2021
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Provider Practice Location Address
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Address Line | 3500 S 70TH ST
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City | FORT SMITH
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State | AR
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Zip | 72903-5197
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Country | US
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Telephone | 479-206-3919
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Fax |
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Provider Business Mailing Address
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Address Line | 6400 MASSARD RD APT 407
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City | FORT SMITH
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State | AR
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Zip | 72916-8861
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Country | US
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Telephone | 479-206-3919
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 8353
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License Number State | AR
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