Healthcare Provider Details

I. General information

NPI: 1114430501
Provider Name (Legal Business Name): PETER R RODRIGUEZ PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8585 SUNSET DR STE 103
MIAMI FL
33143-3753
US

IV. Provider business mailing address

8585 SUNSET DR STE 103
MIAMI FL
33143-3753
US

V. Phone/Fax

Practice location:
  • Phone: 305-274-3311
  • Fax: 305-274-1411
Mailing address:
  • Phone: 305-274-3311
  • Fax: 305-274-1411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT33198
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: