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NPI Code Detail

MEDICARE: NICHOLAS RODRIGUEZ PTA

MEDICARE:   NICHOLAS  RODRIGUEZ  PTA
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
1208100000XPhysical Medicine & Rehabilitation Physician2306604810VA

General Provider Information

NPI Number : 1083238125
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICHOLAS RODRIGUEZ PTA
Provider Business Mailing Address
First Line : 6200 WILSON BLVD APT 712
Second Line :
City : FALLS CHURCH
State : VA
Zip : 22044-3207
Country : US
Telephone Number : 434-989-1260
Fax Number :
Provider Business Practice Location Address
First Line : 7116 FORT HUNT RD
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22307-1900
Country : US
Telephone Number : 434-989-1260
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2020
Last Update Date : 06/04/2020

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Directions to “ NICHOLAS RODRIGUEZ PTA” Practice Location

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