Provider Demographics
NPI:1225263023
Name:RODRIGUEZ, GERARDO UMABEL (LMT)
Entity Type:Individual
Prefix:MR
First Name:GERARDO
Middle Name:UMABEL
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12290 DARTMOOR DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-5530
Mailing Address - Country:US
Mailing Address - Phone:561-302-9897
Mailing Address - Fax:561-795-4443
Practice Address - Street 1:12290 DARTMOOR DR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-5530
Practice Address - Country:US
Practice Address - Phone:561-302-9897
Practice Address - Fax:561-795-4443
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24978225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist