Provider Demographics
NPI:1497295695
Name:RODRIGUEZ, JORGE JOEL (MS, LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:JOEL
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3385
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-3385
Mailing Address - Country:US
Mailing Address - Phone:787-983-1586
Mailing Address - Fax:
Practice Address - Street 1:134 E NORTH ST
Practice Address - Street 2:2ND APT
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-4021
Practice Address - Country:US
Practice Address - Phone:787-983-1586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
20000323262255A2300X
PART0075052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer