Healthcare Provider Details

I. General information

NPI: 1659896926
Provider Name (Legal Business Name): REBECCA RODRIGUEZ PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 08/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PALO ALTO RD STE 140
SAN ANTONIO TX
78211-3773
US

IV. Provider business mailing address

4802 CASTLE ROSE
SAN ANTONIO TX
78218-4133
US

V. Phone/Fax

Practice location:
  • Phone: 210-922-1785
  • Fax:
Mailing address:
  • Phone: 210-787-0115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2114487
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: