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General NPI Number Information
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NPI Number | 1942020102
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Entity Type | Individual
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Provider Name | JESSIE JOSE RODRIGUEZ PTA
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Gender | Male
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Dates
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Enumeration Date | 10/14/2024
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 4100 W INTERSTATE 20
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City | WEATHERFORD
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State | TX
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Zip | 76088-8536
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Country | US
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Telephone | 682-716-0640
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 61216
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City | CORPUS CHRISTI
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State | TX
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Zip | 78466-1216
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Country | US
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Telephone | 682-716-0640
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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 | 2059309
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License Number State | TX
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