Provider Demographics
NPI:1083837991
Name:OCAMPOS, RODRIGO RICCI (RPT)
Entity Type:Individual
Prefix:MR
First Name:RODRIGO
Middle Name:RICCI
Last Name:OCAMPOS
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 1:2039 E EDGEWOOD DR STE 110
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-3601
Mailing Address - Country:US
Mailing Address - Phone:863-665-1185
Mailing Address - Fax:863-665-1761
Practice Address - Street 1:2039 E EDGEWOOD DR STE 110
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3601
Practice Address - Country:US
Practice Address - Phone:863-665-1185
Practice Address - Fax:863-665-1761
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 10173225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT 10173OtherLICENSE NUMBER
FLY8050OtherBCBS PROVIDER NUMBER
FLPT 10173OtherLICENSE NUMBER