MEDICARE: FERNANDO RODRIGUEZ PTA

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	160005776	IL

General Provider Information

NPI Number	:	1659772952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERNANDO RODRIGUEZ PTA

Provider Business Mailing Address
First Line	:	8105 NASHVILLE AVE
Second Line	:
City	:	BURBANK
State	:	IL
Zip	:	60459-1733
Country	:	US
Telephone Number	:	312-848-9362
Fax Number	:

Provider Business Practice Location Address
First Line	:	8105 NASHVILLE AVE
Second Line	:
City	:	BURBANK
State	:	IL
Zip	:	60459-1733
Country	:	US
Telephone Number	:	312-848-9362
Fax Number	:

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

Provider Enumeration Date	:	09/06/2014
Last Update Date	:	09/06/2014

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Directions to “ FERNANDO RODRIGUEZ PTA” Practice Location

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