Healthcare Provider Details

I. General information

NPI: 1083156236
Provider Name (Legal Business Name): JUAN NEFTALI RODRIGUEZ PAZ PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 TOLEDO TER STE A1
HYATTSVILLE MD
20782-4136
US

IV. Provider business mailing address

14205 PARK CENTER DR SUITE 204
LAUREL MD
20707-5246
US

V. Phone/Fax

Practice location:
  • Phone: 301-853-0093
  • Fax: 301-853-0096
Mailing address:
  • Phone: 301-853-0093
  • Fax: 301-853-0096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA4387
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: