Provider Demographics
NPI:1023575214
Name:QUEVEDO, RODRIGO (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:
Last Name:QUEVEDO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 WILLOW GLEN DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79922-2209
Mailing Address - Country:US
Mailing Address - Phone:915-422-8252
Mailing Address - Fax:
Practice Address - Street 1:3100 OLYMPUS BLVD STE 500
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-5473
Practice Address - Country:US
Practice Address - Phone:214-442-4214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1315309225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist