Healthcare Provider Details

I. General information

NPI: 1306771548
Provider Name (Legal Business Name): ADRIENNE KRYSTYN RODRIGUEZ PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 OLD SPRINGTOWN RD STE 114
SPRINGTOWN TX
76082-2772
US

IV. Provider business mailing address

249 FIREFLY DR
SPRINGTOWN TX
76082-3041
US

V. Phone/Fax

Practice location:
  • Phone: 682-394-7778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2155402
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: