Provider Demographics
NPI:1598056566
Name:RODRIGUEZ, GISELLE ANNETTE (MSPT)
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:ANNETTE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSPT
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 2500
Mailing Address - Street 2:PMB 315
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-2500
Mailing Address - Country:US
Mailing Address - Phone:787-567-0120
Mailing Address - Fax:
Practice Address - Street 1:PMB 315
Practice Address - Street 2:BOX 2500
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00977-2500
Practice Address - Country:US
Practice Address - Phone:787-567-0120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist