MEDICARE: MICHELE 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	225200000X	Physical Therapy Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A2057	OTHER	NC	LICENSE#

General Provider Information

NPI Number	:	1346314671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE RODRIGUEZ

Provider Business Mailing Address
First Line	:	8508 HEMPTON CROSS DR
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-4158
Country	:	US
Telephone Number	:	919-217-3572
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 VANDORA SPRINGS RD
Second Line	:
City	:	GARNER
State	:	NC
Zip	:	27529-3545
Country	:	US
Telephone Number	:	919-779-6540
Fax Number	:

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/08/2007

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Directions to “ MICHELE RODRIGUEZ ” Practice Location

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