Provider Demographics
NPI:1093087413
Name:JAUCIAN, RODERICK RAMIREZ (RPT)
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:RAMIREZ
Last Name:JAUCIAN
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 1:9269 PLANTATION ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4557
Mailing Address - Country:US
Mailing Address - Phone:561-753-1557
Mailing Address - Fax:
Practice Address - Street 1:6414 13TH RD S
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33415-1401
Practice Address - Country:US
Practice Address - Phone:561-478-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12862225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist