Provider Demographics
NPI:1407848807
Name:RODEA, VICENTE JR (P T)
Entity Type:Individual
Prefix:MR
First Name:VICENTE
Middle Name:
Last Name:RODEA
Suffix:JR
Gender:M
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 SUN DOWN DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-3916
Mailing Address - Country:US
Mailing Address - Phone:956-425-7662
Mailing Address - Fax:
Practice Address - Street 1:1606 SUN DOWN DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-3916
Practice Address - Country:US
Practice Address - Phone:956-425-7662
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1112548225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist