MEDICARE: SANTA MAYTE 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	4714	AR

General Provider Information

NPI Number	:	1780522003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANTA MAYTE RODRIGUEZ PTA

Provider Business Mailing Address
First Line	:	4708 CORY ST
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-1807
Country	:	US
Telephone Number	:	479-313-1353
Fax Number	:

Provider Business Practice Location Address
First Line	:	4708 CORY ST
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-1807
Country	:	US
Telephone Number	:	479-313-1353
Fax Number	:

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

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	03/25/2026

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