Provider Demographics
NPI:1376988204
Name:RODRIGUEZ, SARA E (PT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2803
Mailing Address - Country:US
Mailing Address - Phone:805-339-0171
Mailing Address - Fax:805-644-4211
Practice Address - Street 1:2727 E MAIN ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2803
Practice Address - Country:US
Practice Address - Phone:805-339-0171
Practice Address - Fax:805-644-4211
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT35192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT35192OtherSTATE LICENSE