Provider Demographics
NPI:1528199155
Name:RODRIGUEZ, ROLAND VINCENT (MPT)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:VINCENT
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PANCOAST RD
Mailing Address - Street 2:
Mailing Address - City:WARETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08758-2653
Mailing Address - Country:US
Mailing Address - Phone:732-232-3943
Mailing Address - Fax:
Practice Address - Street 1:635 BAY AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-3349
Practice Address - Country:US
Practice Address - Phone:732-240-9296
Practice Address - Fax:732-240-9297
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA011378225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist