Provider Demographics
NPI:1578689741
Name:RODEMYER, THOMAS R (PT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:RODEMYER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 43RD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-8401
Mailing Address - Country:US
Mailing Address - Phone:309-743-2070
Mailing Address - Fax:309-743-2073
Practice Address - Street 1:1705 N ANKENY BLVD
Practice Address - Street 2:STE A
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4168
Practice Address - Country:US
Practice Address - Phone:515-964-2559
Practice Address - Fax:515-964-2593
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA04027OtherIOWA PT LICENSE
IA04027OtherIOWA PT LICENSE