=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972279636
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YAMIRKA RODRIGUEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2021
-----------------------------------------------------
Last Update Date | 08/20/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4525 W 20TH AVE APT C329
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-2804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-916-4318
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4525 W 20TH AVE APT C329
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33012-2804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-916-4318
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 29070
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------