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General NPI Number Information
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NPI Number | 1396355137
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Entity Type | Individual
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Provider Name | RYAN RODRIGUEZ
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Gender | Male
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Dates
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Enumeration Date | 08/06/2020
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Last Update Date | 08/06/2020
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Provider Practice Location Address
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Address Line | 1902 59TH ST W
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City | BRADENTON
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State | FL
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Zip | 34209-4602
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Country | US
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Telephone | 813-361-4688
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Fax |
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Provider Business Mailing Address
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Address Line | 1512 E 12TH AVE UNIT 424
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City | TAMPA
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State | FL
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Zip | 33605-3581
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Country | US
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Telephone | 505-489-9605
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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 |
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License Number State |
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