Provider Demographics
NPI:1053824680
Name:RODRIGUEZ, CHRISTINE (DPT)
Entity Type:Individual
Prefix:MISS
First Name:CHRISTINE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 D ST APT A
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-6833
Mailing Address - Country:US
Mailing Address - Phone:305-301-7491
Mailing Address - Fax:
Practice Address - Street 1:1 SAINT JOHNS MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5300
Practice Address - Country:US
Practice Address - Phone:904-824-0869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA50849225700000X
FLPT321512251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist