Healthcare Provider Details

I. General information

NPI: 1447928262
Provider Name (Legal Business Name): YASODA RODRIGUEZ PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2021
Last Update Date: 09/06/2021
Certification Date: 09/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3845 SE LAKE WEIR AVE
OCALA FL
34480-9153
US

IV. Provider business mailing address

PO BOX 1313
ALACHUA FL
32616-1313
US

V. Phone/Fax

Practice location:
  • Phone: 352-693-3378
  • Fax:
Mailing address:
  • Phone: 352-226-6803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number29212
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: