Provider Demographics
NPI:1164968293
Name:RODRIGUEZ-ANTON, JORGE (PTA)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:RODRIGUEZ-ANTON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7223 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1401
Mailing Address - Country:US
Mailing Address - Phone:305-264-0470
Mailing Address - Fax:305-264-5540
Practice Address - Street 1:7223 CORAL WAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1401
Practice Address - Country:US
Practice Address - Phone:305-264-0470
Practice Address - Fax:305-264-5540
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA12749225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant