MEDICARE: MR. VICENTE RODEA JR. P. T.

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	1112548	TX

General Provider Information

NPI Number	:	1407848807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VICENTE RODEA JR. P. T.

Provider Business Mailing Address
First Line	:	1606 SUN DOWN DR
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78552-3916
Country	:	US
Telephone Number	:	956-425-7662
Fax Number	:

Provider Business Practice Location Address
First Line	:	1606 SUN DOWN DR
Second Line	:
City	:	HARLINGEN
State	:	TX
Zip	:	78552-3916
Country	:	US
Telephone Number	:	956-425-7662
Fax Number	:

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	07/08/2007

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