Healthcare Provider Details

I. General information

NPI: 1376462408
Provider Name (Legal Business Name): ZENAIDA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N YORK RD
WILLOW GROVE PA
19090-1326
US

IV. Provider business mailing address

4641 SHELBOURNE ST
PHILADELPHIA PA
19124-3832
US

V. Phone/Fax

Practice location:
  • Phone: 267-625-2412
  • Fax:
Mailing address:
  • Phone: 267-625-2412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG010977
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: