=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235317785
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALEX RODRIGUEZ, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2008
-----------------------------------------------------
Last Update Date | 02/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17150 N BAY RD 2420
-----------------------------------------------------
City | SUNNY ISLES BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33160-3413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-586-6992
-----------------------------------------------------
Fax | 786-207-2798
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17150 N BAY RD 2420
-----------------------------------------------------
City | SUNNY ISLES BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33160-3413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-586-6992
-----------------------------------------------------
Fax | 786-207-2798
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ALEJANDRO RODRIGUEZ
-----------------------------------------------------
Credential | D.P.T.
-----------------------------------------------------
Telephone | 786-586-6992
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT23717
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------