Healthcare Provider Details

I. General information

NPI: 1932085776
Provider Name (Legal Business Name): HAROLD OMAR RODRIGUEZ TH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 CALLE SALUD
PONCE PR
00717-2017
US

IV. Provider business mailing address

BARRIADA MARIANI CALLE OESTE 2503A
PONCE PR
00717-0121
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-7747
  • Fax:
Mailing address:
  • Phone: 787-202-1747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4115
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: