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General NPI Number Information
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NPI Number | 1710669916
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Entity Type | Individual
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Provider Name | TEDDY FONSECA RODRIGUEZ PT
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Gender | Male
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Dates
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Enumeration Date | 08/07/2023
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 16249 BISCAYNE BLVD
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City | AVENTURA
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State | FL
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Zip | 33160-4300
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Country | US
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Telephone | 305-405-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 5244 NW 186TH TER
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City | MIAMI GARDENS
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State | FL
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Zip | 33055-2394
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Country | US
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Telephone | 305-303-7294
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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 | PT40199
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License Number State | FL
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