Healthcare Provider Details

I. General information

NPI: 1629398193
Provider Name (Legal Business Name): DANIELLE RODRIGUEZ P.T., D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 GENESEE ST
AUBURN NY
13021-3231
US

IV. Provider business mailing address

278 GENESEE ST
AUBURN NY
13021-3231
US

V. Phone/Fax

Practice location:
  • Phone: 315-282-0067
  • Fax: 315-282-0587
Mailing address:
  • Phone: 315-282-0067
  • Fax: 315-282-0587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number032705-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: