Provider Demographics
NPI:1417309113
Name:RODRIGUEZ, ELAINE AIXA (MPT)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:AIXA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 CALLE SHEQUEL
Mailing Address - Street 2:LA PROVIDENCIA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-3139
Mailing Address - Country:US
Mailing Address - Phone:787-432-9868
Mailing Address - Fax:
Practice Address - Street 1:2410 CALLE SHEQUEL
Practice Address - Street 2:LA PROVIDENCIA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-3139
Practice Address - Country:US
Practice Address - Phone:787-432-9868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR874225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist