Provider Demographics
NPI:1467630160
Name:PREMRL RODRIGUEZ, MILKA T (LMT,NCTMB)
Entity Type:Individual
Prefix:
First Name:MILKA
Middle Name:T
Last Name:PREMRL RODRIGUEZ
Suffix:
Gender:M
Credentials:LMT,NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 PALERMO AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6907
Mailing Address - Country:US
Mailing Address - Phone:305-448-7409
Mailing Address - Fax:
Practice Address - Street 1:3310 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-7284
Practice Address - Country:US
Practice Address - Phone:786-417-7234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA52079225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist