Healthcare Provider Details

I. General information

NPI: 1255113536
Provider Name (Legal Business Name): CHRISTINE ALEXANDRA RODRIGUEZ PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OPC 80 BOX 5217
APO AP
96368-9503
US

IV. Provider business mailing address

18 MEDICAL GROUP (MDG) UNIT 5142 OPC 80 BOX 5217 KADENA AB, OKINAWA, JAPAN
APO AP
96368-5217
US

V. Phone/Fax

Practice location:
  • Phone: 315-630-4780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number304900
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: