MEDICARE: MR. ROGELIO RODRIGUEZ JR. 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	225100000X	Physical Therapist	2077057	TX

General Provider Information

NPI Number	:	1760768824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROGELIO RODRIGUEZ JR. PTA

Provider Business Mailing Address
First Line	:	805 S OKLAHOMA AVE
Second Line	:
City	:	WESLACO
State	:	TX
Zip	:	78596-6931
Country	:	US
Telephone Number	:	956-472-8124
Fax Number	:

Provider Business Practice Location Address
First Line	:	805 S OKLAHOMA AVE
Second Line	:
City	:	WESLACO
State	:	TX
Zip	:	78596-6931
Country	:	US
Telephone Number	:	956-472-8124
Fax Number	:

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

Provider Enumeration Date	:	11/02/2011
Last Update Date	:	11/02/2011

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