Provider Demographics
NPI:1407071632
Name:RODRIGUEZ, SUZANNE F (MSPT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:F
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:BASTOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:166 ROUND HILL RD
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-1631
Mailing Address - Country:US
Mailing Address - Phone:203-910-1863
Mailing Address - Fax:
Practice Address - Street 1:1050 NE 125TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5805
Practice Address - Country:US
Practice Address - Phone:305-891-8850
Practice Address - Fax:305-357-9372
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22799225100000X
CT007917225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist