Healthcare Provider Details

I. General information

NPI: 1881519239
Provider Name (Legal Business Name): SEAN KIM RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19511 HIGHLAND OAKS DR
ESTERO FL
33928-9711
US

IV. Provider business mailing address

6200 MAHAFFEY RD UNIT 305
FORT MYERS FL
33966-1647
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-1999
  • Fax:
Mailing address:
  • Phone: 352-708-0705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number45080
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: