MEDICARE: ROBERT RODRIGUEZ L.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	1016541	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	742795605	OTHER	TX	TAX ID

General Provider Information

NPI Number	:	1821056243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT RODRIGUEZ L.P.T.

Provider Business Mailing Address
First Line	:	1356 FM 2673
Second Line	:
City	:	CANYON LAKE
State	:	TX
Zip	:	78133-4510
Country	:	US
Telephone Number	:	830-907-2145
Fax Number	:	830-964-2373

Provider Business Practice Location Address
First Line	:	1356 FM 2673
Second Line	:
City	:	CANYON LAKE
State	:	TX
Zip	:	78133-4510
Country	:	US
Telephone Number	:	830-907-2145
Fax Number	:	830-964-2373

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	10/21/2021

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