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General NPI Number Information
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NPI Number | 1912264037
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Entity Type | Individual
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Provider Name | MARIO GREGORIO RODRIGUEZ PT
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Gender | Male
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Dates
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Enumeration Date | 04/13/2012
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Last Update Date | 04/13/2012
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Provider Practice Location Address
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Address Line | 3056 SANDSTONE CIRCLE
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City | ST CLOUD
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State | FL
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Zip | 34772
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Country | US
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Telephone | 407-957-7819
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Fax |
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Provider Business Mailing Address
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Address Line | 3056 SANDSTONE CIR
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City | SAINT CLOUD
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State | FL
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Zip | 34772-6525
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Country | US
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Telephone | 407-957-7819
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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 | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | PT 11740
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License Number State | FL
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