1164498119 NPI number — MS. BECKY JEAN RODDA PT, MHS, OCS

Table of content: MS. BECKY JEAN RODDA PT, MHS, OCS (NPI 1164498119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164498119 NPI number — MS. BECKY JEAN RODDA PT, MHS, OCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODDA
Provider First Name:
BECKY
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT, MHS, OCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164498119
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6211 COBBLERS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48823-7829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-333-3194
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3544 MERIDIAN CROSSINGS
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
OKEMOS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48864-6025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-347-2495
Provider Business Practice Location Address Fax Number:
517-347-3540
Provider Enumeration Date:
02/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  5501002266 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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