MEDICARE: RODRIGUEZ MASSAGE THERAPY

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	172M00000X	Mechanotherapist	MA58519	FL

General Provider Information

NPI Number	:	1992139208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RODRIGUEZ MASSAGE THERAPY

Provider Business Mailing Address
First Line	:	7116 SW 152ND PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-1603
Country	:	US
Telephone Number	:	305-763-9963
Fax Number	:	305-938-0566

Provider Business Practice Location Address
First Line	:	7116 SW 152ND PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-1603
Country	:	US
Telephone Number	:	305-763-9963
Fax Number	:	305-938-0566

Authorized Official
Title or Position	:	OWNER
Name	:	JOSE M RODRIGUEZ
Credential	:
Telephone Number	:	305-763-9963

Provider Enumeration Date	:	08/23/2013
Last Update Date	:	08/23/2013

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