=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407886922
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY RODRIGUEZ PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100360 OVERSEAS HWY
-----------------------------------------------------
City | KEY LARGO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33037-2586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-453-0409
-----------------------------------------------------
Fax | 305-453-0570
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 279 SAINT THOMAS AVE
-----------------------------------------------------
City | KEY LARGO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33037-4321
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-451-4858
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT12174
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------