Provider Demographics
NPI:1073161261
Name:RODRIGUEZ, ALISHA MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:MARIE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:MARIE
Other - Last Name:SPARLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:204 HIDDEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-9683
Mailing Address - Country:US
Mailing Address - Phone:774-279-1929
Mailing Address - Fax:
Practice Address - Street 1:201 CALLE DE LOS MOLINOS
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-3874
Practice Address - Country:US
Practice Address - Phone:949-388-5692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300107225100000X
SC9823225100000X
NCP21869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist