MEDICARE: DR. JOHNPAUL RODRIGUES 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
1	225100000X	Physical Therapist	1265528	TX

General Provider Information

NPI Number	:	1790167815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHNPAUL RODRIGUES PT, DPT

Provider Business Mailing Address
First Line	:	3102 SKYLINE DR
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-3168
Country	:	US
Telephone Number	:	936-615-3325
Fax Number	:

Provider Business Practice Location Address
First Line	:	227 RUSSELL BLVD
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-1238
Country	:	US
Telephone Number	:	936-564-4596
Fax Number	:

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

Provider Enumeration Date	:	06/25/2015
Last Update Date	:	07/22/2024

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