Provider Demographics
NPI:1104369768
Name:RODRIGUEZ, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10323 CROSS CREEK BLVD
Mailing Address - Street 2:SUITE D-4
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2988
Mailing Address - Country:US
Mailing Address - Phone:813-766-1691
Mailing Address - Fax:
Practice Address - Street 1:10323 CROSS CREEK BLVD
Practice Address - Street 2:SUITE D-4
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2988
Practice Address - Country:US
Practice Address - Phone:813-766-1691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer