Provider Demographics
NPI:1235538455
Name:RODRIGUEZ, KENNETH (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3453 N PANAM EXPY
Mailing Address - Street 2:STE 110
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78219-2333
Mailing Address - Country:US
Mailing Address - Phone:210-226-7767
Mailing Address - Fax:210-226-9656
Practice Address - Street 1:3453 N PANAM EXPY
Practice Address - Street 2:STE 110
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78219-2333
Practice Address - Country:US
Practice Address - Phone:210-226-7767
Practice Address - Fax:210-226-9656
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12467892251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic