MEDICARE: MRS. ANTJE MARIANNE RODNEY P.T.

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	225100000X	Physical Therapist	5501004439	MI

General Provider Information

NPI Number	:	1740551837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANTJE MARIANNE RODNEY P.T.

Provider Business Mailing Address
First Line	:	107 POWELL BLVD APT 3204
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-7160
Country	:	US
Telephone Number	:	313-917-5756
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 POWELL BLVD APT 3204
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-7160
Country	:	US
Telephone Number	:	313-917-5756
Fax Number	:

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

Provider Enumeration Date	:	01/20/2012
Last Update Date	:	01/20/2012

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