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General NPI Number Information
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NPI Number | 1730165945
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Entity Type | Individual
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Provider Name | ANTONIO RODRIGUEZ JR. PTA
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Gender | Male
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Dates
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Enumeration Date | 12/20/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1400 N WESTGATE DR STE 104
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City | WESLACO
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State | TX
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Zip | 78596-4396
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Country | US
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Telephone | 956-565-2929
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Fax | 956-565-6939
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Provider Business Mailing Address
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Address Line | 516 E ROOSEVELT ST
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City | WESLACO
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State | TX
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Zip | 78596-8811
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Country | US
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Telephone | 956-867-1052
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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 | 2055972
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License Number State | TX
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