Healthcare Provider Details

I. General information

NPI: 1568370609
Provider Name (Legal Business Name): ELVIS RODRIGUEZ PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

151 VICTORIA COMMONS BLVD STE 107
DELAND FL
32724-7722
US

IV. Provider business mailing address

4856 VERACITY PT APT 326
SANFORD FL
32771-7573
US

V. Phone/Fax

Practice location:
  • Phone: 386-943-4690
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT45266
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: