Provider Demographics
NPI:1528593209
Name:RODRIGUEZ, DAMIAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DAMIAN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 ASH LN
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-4228
Mailing Address - Country:US
Mailing Address - Phone:210-744-7617
Mailing Address - Fax:
Practice Address - Street 1:1441 S MIDLOTHIAN PKWY
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5591
Practice Address - Country:US
Practice Address - Phone:972-723-0380
Practice Address - Fax:972-723-0276
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1287528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist