=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740999127
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIANA M RODRIGUEZ DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2022
-----------------------------------------------------
Last Update Date | 04/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1275 W PUEBLO BLVD
-----------------------------------------------------
City | PUEBLO
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81004-3866
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-542-0589
-----------------------------------------------------
Fax | 719-542-0119
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7622 MCLAUGHLIN RD
-----------------------------------------------------
City | PEYTON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80831-4710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-495-3133
-----------------------------------------------------
Fax | 719-471-4415
-----------------------------------------------------
=====================================================
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 | PTL.0018789
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------