Provider Demographics
NPI:1073524039
Name:RODRIGUEZ, ROBERTO GERARDO (RPT)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:GERARDO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 STIRLING RD
Mailing Address - Street 2:APT. 420
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-1579
Mailing Address - Country:US
Mailing Address - Phone:954-435-9272
Mailing Address - Fax:
Practice Address - Street 1:7676 PETERS RD
Practice Address - Street 2:SUITE C
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-4032
Practice Address - Country:US
Practice Address - Phone:954-474-4403
Practice Address - Fax:954-474-4706
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT4621225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist