Basic Information
| Provider Information | |||||||||
| NPI: | 1902271919 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RHODES | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | WHITTEN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 KRISTEN CV | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391106641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016721803 | ||||||||
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| Practice Location | |||||||||
| Address1: | 108 CLINTON PKWY | ||||||||
| Address2: | BAPTIST PT-CLINTON | ||||||||
| City: | CLINTON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 390564730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019262018 | ||||||||
| FaxNumber: | 6019249746 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2015 | ||||||||
| LastUpdateDate: | 08/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT3644 | MS | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 07778736 | 05 | MS | MEDICAID |