Provider Demographics
NPI:1386661981
Name:RODRIGUEZ, STARRLA K (PT)
Entity Type:Individual
Prefix:MRS
First Name:STARRLA
Middle Name:K
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:STARRLA
Other - Middle Name:K
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 8150
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78468-8150
Mailing Address - Country:US
Mailing Address - Phone:361-723-0079
Mailing Address - Fax:361-814-7009
Practice Address - Street 1:4918 HOLLY STE. B
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411
Practice Address - Country:US
Practice Address - Phone:361-723-0079
Practice Address - Fax:361-814-7009
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1127157225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8G8226Medicare PIN