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NPI Code Detail

MEDICARE: RODRIGO QUEVEDO PT, DPT

MEDICARE: RODRIGO QUEVEDO PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1315309TX

General Provider Information

NPI Number : 1023575214
Entity Type Code : Individual
Provider Name (Legal Business Name) : RODRIGO QUEVEDO PT, DPT
Provider Business Mailing Address
First Line : 624 WILLOW GLEN DR
Second Line :
City : EL PASO
State : TX
Zip : 79922-2209
Country : US
Telephone Number : 915-422-8252
Fax Number :
Provider Business Practice Location Address
First Line : 3100 OLYMPUS BLVD STE 500
Second Line :
City : COPPELL
State : TX
Zip : 75019-5473
Country : US
Telephone Number : 214-442-4214
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2019
Last Update Date : 02/25/2019

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