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General NPI Number Information
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NPI Number | 1356202857
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Entity Type | Individual
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Provider Name | RODRIGO LOPEZ DIAZ PTA
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Gender | Male
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 3906 S 27TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53221-1826
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Country | US
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Telephone | 414-281-3444
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Fax |
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Provider Business Mailing Address
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Address Line | 907 W TAYLOR ST
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City | BLOOMINGTON
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State | IL
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Zip | 61701-4912
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Country | US
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Telephone | 309-287-3153
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160010327
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License Number State | IL
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