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NPI Code Detail

MEDICARE: JENNA RODRIGUEZ PT, DPT

MEDICARE: JENNA RODRIGUEZ PT, DPT
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
1225100000XPhysical Therapist40QA02202300NJ

General Provider Information

NPI Number : 1578346813
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNA RODRIGUEZ PT, DPT
Provider Business Mailing Address
First Line : 1650 LYNDON FARM CT STE 300
Second Line :
City : LOUISVILLE
State : KY
Zip : 40223-5005
Country : US
Telephone Number : 856-677-4000
Fax Number : 856-234-3014
Provider Business Practice Location Address
First Line : 1900 MOUNT HOLLY RD STE 4C
Second Line :
City : BURLINGTON
State : NJ
Zip : 08016-4725
Country : US
Telephone Number : 609-747-1915
Fax Number : 609-747-8565
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2023
Last Update Date : 08/18/2023

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