Healthcare Provider Details

I. General information

NPI: 1013214485
Provider Name (Legal Business Name): LAUREN RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 OAKWOOD BLVD STE 130
HOLLYWOOD FL
33020-1956
US

IV. Provider business mailing address

1 OAKWOOD BLVD STE 130
HOLLYWOOD FL
33020-1956
US

V. Phone/Fax

Practice location:
  • Phone: 954-925-3844
  • Fax: 954-925-3845
Mailing address:
  • Phone: 954-925-3844
  • Fax: 954-925-3845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA20085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: