Healthcare Provider Details

I. General information

NPI: 1831847250
Provider Name (Legal Business Name): PRISCILLA RENAE RODRIGUEZ PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 LOUIS PASTEUR DR STE 144
SAN ANTONIO TX
78229-4534
US

IV. Provider business mailing address

2101 N 23RD ST
MCALLEN TX
78501-6127
US

V. Phone/Fax

Practice location:
  • Phone: 210-290-9335
  • Fax:
Mailing address:
  • Phone: 956-687-4560
  • Fax: 956-618-1342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2151123
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: