Healthcare Provider Details

I. General information

NPI: 1013554500
Provider Name (Legal Business Name): ERIC MATTHEW RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7939 PAT BOOKER RD STE 120
LIVE OAK TX
78233-2776
US

IV. Provider business mailing address

PO BOX 306393
NASHVILLE TN
37230-6393
US

V. Phone/Fax

Practice location:
  • Phone: 210-660-2345
  • Fax: 210-446-1442
Mailing address:
  • Phone: 615-373-1350
  • Fax: 615-221-9054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number00000
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: