Provider Demographics
NPI:1093067779
Name:RODRIGUEZ, JESSICA JEAN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JEAN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:JESISCA
Other - Middle Name:JEAN
Other - Last Name:SPAYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:920 JEANNETTE AVE
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-2324
Mailing Address - Country:US
Mailing Address - Phone:818-384-1980
Mailing Address - Fax:
Practice Address - Street 1:920 JEANNETTE AVE
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-2324
Practice Address - Country:US
Practice Address - Phone:818-384-1980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist