=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699631515
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLAS RODRIGUEZ
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2026
-----------------------------------------------------
Last Update Date | 01/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7061 HIGHWAY 72 W STE B
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35806-2959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-261-3531
-----------------------------------------------------
Fax | 256-715-7889
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7061 HIGHWAY 72 W STE B
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35806-2959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
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 | PTH12561
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------