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NPI Code Detail

MEDICARE: MR. JESRAEL T RODRIGUEZ SR.

MEDICARE: MR. JESRAEL T RODRIGUEZ SR.
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
12251G0304XGeriatric Physical TherapistPT10074FL
2225100000XPhysical Therapist

General Provider Information

NPI Number : 1093412777
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JESRAEL T RODRIGUEZ SR.
Provider Business Mailing Address
First Line : 1069 HARMONY LN
Second Line :
City : CLERMONT
State : FL
Zip : 34711-9021
Country : US
Telephone Number : 863-899-0768
Fax Number :
Provider Business Practice Location Address
First Line : 701 LAKE PORT BLVD
Second Line :
City : LEESBURG
State : FL
Zip : 34748-7674
Country : US
Telephone Number : 352-728-3366
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2023
Last Update Date : 02/13/2023

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