Healthcare Provider Details

I. General information

NPI: 1740999127
Provider Name (Legal Business Name): BRIANA M RODRIGUEZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 W PUEBLO BLVD
PUEBLO CO
81004-3866
US

IV. Provider business mailing address

7622 MCLAUGHLIN RD
PEYTON CO
80831-4710
US

V. Phone/Fax

Practice location:
  • Phone: 719-542-0589
  • Fax: 719-542-0119
Mailing address:
  • Phone: 719-495-3133
  • Fax: 719-471-4415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL.0018789
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: