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General NPI Number Information
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NPI Number | 1508310764
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Entity Type | Individual
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Provider Name | EVELIO RODRIGUEZ PTA
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Gender | Male
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Dates
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Enumeration Date | 08/04/2016
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 10794 PINES BLVD STE 104
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-3920
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Country | US
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Telephone | 954-735-3535
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Fax |
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Provider Business Mailing Address
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Address Line | 15096 SW 20TH LN
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City | MIAMI
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State | FL
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Zip | 33185-5680
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Country | US
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Telephone | 786-838-3602
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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 | 26580
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License Number State | FL
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