MEDICARE: PRISCILLA RENAE 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	2151123	TX

General Provider Information

NPI Number	:	1831847250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRISCILLA RENAE RODRIGUEZ PTA

Provider Business Mailing Address
First Line	:	2101 N 23RD ST
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78501-6127
Country	:	US
Telephone Number	:	956-687-4560
Fax Number	:	956-618-1342

Provider Business Practice Location Address
First Line	:	7220 LOUIS PASTEUR DR STE 144
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4534
Country	:	US
Telephone Number	:	210-290-9335
Fax Number	:

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

Provider Enumeration Date	:	03/15/2022
Last Update Date	:	03/15/2022

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Directions to “ PRISCILLA RENAE RODRIGUEZ PTA” Practice Location

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