Provider Demographics
NPI:1427382852
Name:RODRIGUEZ, JESSICA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 8194
Mailing Address - Street 2:BO. ESPINO
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-9536
Mailing Address - Country:US
Mailing Address - Phone:787-449-2893
Mailing Address - Fax:
Practice Address - Street 1:HC 3 BOX 8194
Practice Address - Street 2:BO. ESPINO
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-9536
Practice Address - Country:US
Practice Address - Phone:787-449-2893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1248172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker