Provider Demographics
NPI:1346571494
Name:RODRIGUEZ, SYLVIA (PTA)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 LAUREL OAK WAY
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-7348
Mailing Address - Country:US
Mailing Address - Phone:956-661-0475
Mailing Address - Fax:956-630-9941
Practice Address - Street 1:7007 N 10TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3104
Practice Address - Country:US
Practice Address - Phone:956-661-0475
Practice Address - Fax:956-661-0482
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2008603225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1434045Medicaid