Healthcare Provider Details

I. General information

NPI: 1255675450
Provider Name (Legal Business Name): NATALIE KAYE RODRIGUEZ PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2012
Last Update Date: 11/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 W 49TH AVE
HOBART IN
46342-3744
US

IV. Provider business mailing address

4410 W 49TH AVE
HOBART IN
46342-3744
US

V. Phone/Fax

Practice location:
  • Phone: 219-947-1507
  • Fax: 219-942-3279
Mailing address:
  • Phone: 219-947-1507
  • Fax: 219-942-3279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06003243A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: