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NPI Code Detail

MEDICARE: IVEY D RHOADES PTA

MEDICARE:   IVEY D RHOADES  PTA
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
1225200000XPhysical Therapy AssistantPTA002281GA

General Provider Information

NPI Number : 1245448273
Entity Type Code : Individual
Provider Name (Legal Business Name) : IVEY D RHOADES PTA
Provider Business Mailing Address
First Line : 185 WESTOVER DR
Second Line :
City : ATHENS
State : GA
Zip : 30606-2749
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 100 MOUNTAIN VIEW DR
Second Line : SUITE 100
City : CUMMING
State : GA
Zip : 30040-2434
Country : US
Telephone Number : 770-889-2163
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2007
Last Update Date : 07/08/2007

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Directions to “ IVEY D RHOADES PTA” Practice Location

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