Healthcare Provider Details

I. General information

NPI: 1093623035
Provider Name (Legal Business Name): ALYSHA RODRIGUEZ
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 S LOWE AVE STE K
COOKEVILLE TN
38501-4703
US

IV. Provider business mailing address

PO BOX 49396
COOKEVILLE TN
38506-0396
US

V. Phone/Fax

Practice location:
  • Phone: 931-260-7224
  • Fax:
Mailing address:
  • Phone: 888-423-2559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: