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General NPI Number Information
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NPI Number | 1790167815
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Entity Type | Individual
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Provider Name | JOHNPAUL RODRIGUES PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 06/25/2015
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 227 RUSSELL BLVD
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City | NACOGDOCHES
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State | TX
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Zip | 75965-1238
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Country | US
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Telephone | 936-564-4596
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Fax |
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Provider Business Mailing Address
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Address Line | 3102 SKYLINE DR
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City | NACOGDOCHES
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State | TX
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Zip | 75965-3168
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Country | US
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Telephone | 936-615-3325
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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 | 1265528
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License Number State | TX
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