MEDICARE: MRS. STACY RACHELLE RODRIGUEZ MSPT

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	PT23833	FL

General Provider Information

NPI Number	:	1922285758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACY RACHELLE RODRIGUEZ MSPT

Provider Business Mailing Address
First Line	:	1011 N STATE ROAD 7 STE A
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-5184
Country	:	US
Telephone Number	:	561-784-3767
Fax Number	:	561-784-9346

Provider Business Practice Location Address
First Line	:	1011 N STATE ROAD 7 STE A
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-5184
Country	:	US
Telephone Number	:	561-784-3767
Fax Number	:	561-784-9346

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

Provider Enumeration Date	:	01/23/2008
Last Update Date	:	01/23/2008

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