MEDICARE: DEANNA RODRIGUEZ PT, DPT

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	302040	CA

General Provider Information

NPI Number	:	1851039143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA RODRIGUEZ PT, DPT

Provider Business Mailing Address
First Line	:	4250 GLENCOE AVE UNIT 1325
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-5685
Country	:	US
Telephone Number	:	908-377-1502
Fax Number	:

Provider Business Practice Location Address
First Line	:	4250 GLENCOE AVE UNIT 1325
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-5685
Country	:	US
Telephone Number	:	908-377-1502
Fax Number	:

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

Provider Enumeration Date	:	05/25/2022
Last Update Date	:	05/25/2022

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