Provider Demographics
NPI:1003151077
Name:RODRIGUEZ, RODRIGO D (PT,DPT,CWS,WCC)
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:D
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PT,DPT,CWS,WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1573 S CATAWBA CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80018-6012
Mailing Address - Country:US
Mailing Address - Phone:720-473-9791
Mailing Address - Fax:
Practice Address - Street 1:1573 S CATAWBA CIR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80018-6012
Practice Address - Country:US
Practice Address - Phone:720-473-9791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2015-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6842225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist