Healthcare Provider Details

I. General information

NPI: 1013553486
Provider Name (Legal Business Name): CASSANDRA RODRIGUEZ PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5860 COLLEGE RD
KEY WEST FL
33040-4314
US

IV. Provider business mailing address

2337 PATTERSON AVE
KEY WEST FL
33040-3815
US

V. Phone/Fax

Practice location:
  • Phone: 305-296-4888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA21823
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: