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General NPI Number Information
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NPI Number | 1417647884
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Entity Type | Individual
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Provider Name | ILEIA NICOLE RODRIGUEZ PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 05/10/2023
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Last Update Date | 05/10/2023
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Provider Practice Location Address
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Address Line | 23175 COMMERCE PARK
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City | BEACHWOOD
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State | OH
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Zip | 44122-5806
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Country | US
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Telephone | 440-449-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 11270 APACHE DR APT 301
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City | PARMA HEIGHTS
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State | OH
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Zip | 44130-9039
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Country | US
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Telephone | 330-671-0784
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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 | PT020376
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License Number State | OH
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