Provider Demographics
NPI:1093287518
Name:RODRIGUEZ, CATHARINE LEIGH (PTA)
Entity Type:Individual
Prefix:
First Name:CATHARINE
Middle Name:LEIGH
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 W BOIS DARC ST
Mailing Address - Street 2:
Mailing Address - City:EDNA
Mailing Address - State:TX
Mailing Address - Zip Code:77957-2512
Mailing Address - Country:US
Mailing Address - Phone:979-204-2236
Mailing Address - Fax:
Practice Address - Street 1:535 S AUSTIN RD
Practice Address - Street 2:
Practice Address - City:EAGLE LAKE
Practice Address - State:TX
Practice Address - Zip Code:77434-3001
Practice Address - Country:US
Practice Address - Phone:979-243-3910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2098419225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant