Provider Demographics
NPI:1497211718
Name:RODRIGUEZ, THELMA ROSA
Entity Type:Individual
Prefix:
First Name:THELMA
Middle Name:ROSA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3337 BETTERTON CIR
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-2513
Mailing Address - Country:US
Mailing Address - Phone:305-484-0704
Mailing Address - Fax:
Practice Address - Street 1:3337 BETTERTON CIR
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-2513
Practice Address - Country:US
Practice Address - Phone:410-879-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant