MEDICARE: STEPHANIE RODRIGUEZ

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	P160071457	WA
2	225200000X	Physical Therapy Assistant	9554	CA

General Provider Information

NPI Number	:	1861776916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE RODRIGUEZ

Provider Business Mailing Address
First Line	:	1249 SE HIGH RIDGE CT
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98367-9656
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1249 SE HIGH RIDGE CT
Second Line	:
City	:	PORT ORCHARD
State	:	WA
Zip	:	98367-9656
Country	:	US
Telephone Number	:	360-271-3909
Fax Number	:

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

Provider Enumeration Date	:	10/07/2011
Last Update Date	:	10/07/2011

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Directions to “ STEPHANIE RODRIGUEZ ” Practice Location

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