MEDICARE: VANESSA NICOLE RODRIGUEZ 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
1	225100000X	Physical Therapist	PT40638	FL

General Provider Information

NPI Number	:	1053166181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA NICOLE RODRIGUEZ DPT

Provider Business Mailing Address
First Line	:	265 NW 123RD AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33182-1261
Country	:	US
Telephone Number	:	305-343-7040
Fax Number	:

Provider Business Practice Location Address
First Line	:	1688 MERIDIAN AVE STE 600
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-2714
Country	:	US
Telephone Number	:	305-874-0839
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2024
Last Update Date	:	04/22/2024

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