MEDICARE: SUSAN RHODES L.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133NN1002X	Nutrition Education Nutritionist	LD 5675	OH
2	133V00000X	Registered Dietitian	DT84978	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RHMT73321	OTHER	OH	PIN NUMBER
2	DT84978	OTHER	TN	COMMISSION ON DIETETIC REGISTRATION

General Provider Information

NPI Number	:	1164453403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN RHODES L.D.

Provider Business Mailing Address
First Line	:	1420 VICEROY DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-2208
Country	:	US
Telephone Number	:	214-358-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 8TH AVE STE 135
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4156
Country	:	US
Telephone Number	:	817-923-8050
Fax Number	:	817-920-0562

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	04/17/2019

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Directions to “ SUSAN RHODES L.D.” Practice Location

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