=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306771548
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADRIENNE KRYSTYN RODRIGUEZ PTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2026
-----------------------------------------------------
Last Update Date | 06/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 407 OLD SPRINGTOWN RD STE 114
-----------------------------------------------------
City | SPRINGTOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76082-2772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-394-7778
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 249 FIREFLY DR
-----------------------------------------------------
City | SPRINGTOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76082-3041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 2155402
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------