Healthcare Provider Details

I. General information

NPI: 1851221683
Provider Name (Legal Business Name): MARJORIE RODRIGUEZ PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 SUNRISE PLAZA DR STE 6
CLERMONT FL
34714-6202
US

IV. Provider business mailing address

PO BOX 135366
CLERMONT FL
34713-5366
US

V. Phone/Fax

Practice location:
  • Phone: 321-221-4629
  • Fax:
Mailing address:
  • Phone: 321-221-4629
  • Fax: 321-221-4629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT12322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: