MEDICARE: AARON MATTHEW RODRIGUEZ

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1134753742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON MATTHEW RODRIGUEZ

Provider Business Mailing Address
First Line	:	555 BOWERS BLVD.
Second Line	:	APRT#1122
City	:	HUNTSVILLE
State	:	TX
Zip	:	77340
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 UNIVERSITY AVE
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77341-0001
Country	:	US
Telephone Number	:	832-969-5239
Fax Number	:

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

Provider Enumeration Date	:	02/24/2020
Last Update Date	:	02/24/2020

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