Provider Demographics
NPI:1487219457
Name:RODRIGUEZ, DAMARIS (PT)
Entity Type:Individual
Prefix:MRS
First Name:DAMARIS
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB SIERRA BAYAMON
Mailing Address - Street 2:8-5 CALLE 5
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-3673
Mailing Address - Country:US
Mailing Address - Phone:787-782-8250
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 8.5
Practice Address - Street 2:BO JUAN SANCHEZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-782-8250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR964225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist