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General NPI Number Information
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NPI Number | 1306530118
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Entity Type | Individual
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Provider Name | MARIAM RODRIGUEZ DPT
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Gender | Female
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 1105 53RD AVE E
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City | BRADENTON
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State | FL
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Zip | 34203-4897
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Country | US
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Telephone | 941-755-2562
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Fax |
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Provider Business Mailing Address
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Address Line | 6506 W COMANCHE AVE
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City | TAMPA
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State | FL
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Zip | 33634-5044
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Country | US
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Telephone | 813-735-3269
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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 | PTT40280
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License Number State | FL
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