MEDICARE: CODY RHOADES RBT

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1871468777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY RHOADES RBT

Provider Business Mailing Address
First Line	:	2193 L G RUSSELL RD
Second Line	:
City	:	BAKER
State	:	FL
Zip	:	32531-7477
Country	:	US
Telephone Number	:	850-585-9189
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 STATE HIGHWAY 83
Second Line	:
City	:	DEFUNIAK SPGS
State	:	FL
Zip	:	32433-7404
Country	:	US
Telephone Number	:	850-585-9189
Fax Number	:

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

Provider Enumeration Date	:	10/09/2025
Last Update Date	:	10/09/2025

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Directions to “ CODY RHOADES RBT” Practice Location

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