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General NPI Number Information
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NPI Number | 1225582067
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Entity Type | Individual
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Provider Name | JESSICA RAE RODRIGUEZ PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 08/10/2016
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Last Update Date | 11/02/2022
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Provider Practice Location Address
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Address Line | 721 METROPOLITAN AVE STE C
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City | LEAVENWORTH
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State | KS
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Zip | 66048-1403
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Country | US
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Telephone | 913-250-5452
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Fax |
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Provider Business Mailing Address
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Address Line | 77 6TH INFANTRY RD
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City | FORT LEAVENWORTH
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State | KS
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Zip | 66027-1146
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Country | US
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Telephone | 706-251-5311
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11-06966
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License Number State | KS
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