MEDICARE: ILSA RODRIGUEZ

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	0752	PR

General Provider Information

NPI Number	:	1003151846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILSA RODRIGUEZ

Provider Business Mailing Address
First Line	:	PASEO DEL PARQUE
Second Line	:	#92 MEDICI ST.
City	:	SAN JUAN
State	:	PR
Zip	:	00926-6514
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PASEO DEL PARQUE
Second Line	:	#92 MEDICI ST.
City	:	SAN JUAN
State	:	PR
Zip	:	00926-6514
Country	:	US
Telephone Number	:	787-292-0627
Fax Number	:

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

Provider Enumeration Date	:	12/05/2012
Last Update Date	:	12/05/2012

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Directions to “ ILSA RODRIGUEZ ” Practice Location

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