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General NPI Number Information
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NPI Number | 1922788603
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Entity Type | Individual
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Provider Name | COLIN BRYCE RODMAN PTA
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Gender | Male
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Dates
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Enumeration Date | 07/19/2023
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 3111 W BOYNTON BEACH BLVD STE 200
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City | BOYNTON BEACH
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State | FL
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Zip | 33436-4613
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Country | US
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Telephone | 561-742-3282
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Fax |
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Provider Business Mailing Address
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Address Line | 750 NE SPANISH RIVER BLVD APT 310
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City | BOCA RATON
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State | FL
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Zip | 33431-6141
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Country | US
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Telephone | 860-869-2145
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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 | PTA27398
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License Number State | FL
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