Provider Demographics
NPI:1225256662
Name:RODRIGUEZ, MARY DONNA J (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY DONNA
Middle Name:J
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:894 ISLAND WAY
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33767-1825
Mailing Address - Country:US
Mailing Address - Phone:727-430-3163
Mailing Address - Fax:
Practice Address - Street 1:21905 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-2342
Practice Address - Country:US
Practice Address - Phone:727-669-4245
Practice Address - Fax:727-669-6835
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0001141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist