MEDICARE: MR. HUGO ROBERTO RODRIGUEZ MSPT

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	6804	AZ

General Provider Information

NPI Number	:	1144368705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HUGO ROBERTO RODRIGUEZ MSPT

Provider Business Mailing Address
First Line	:	9097 E DESERT COVE DR
Second Line	:	SUITE 110
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-6279
Country	:	US
Telephone Number	:	602-285-0949
Fax Number	:	602-285-0052

Provider Business Practice Location Address
First Line	:	1847 W HEATHERBRAE DR
Second Line	:	SUITE B
City	:	PHOENIX
State	:	AZ
Zip	:	85015-4764
Country	:	US
Telephone Number	:	602-285-0949
Fax Number	:	602-285-0052

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/30/2007

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