Healthcare Provider Details

I. General information

NPI: 1215068036
Provider Name (Legal Business Name): MARIA N RODRIGUES PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SEA ISLE DR
SOUTH FALLSBURG NY
12779-5632
US

IV. Provider business mailing address

2 SEA ISLE DR
SOUTH FALLSBURG NY
12779-5632
US

V. Phone/Fax

Practice location:
  • Phone: 845-436-6921
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number016969
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: