Provider Demographics
NPI:1609183789
Name:RODRIGUEZ, DENNIS (DENNIS RODRIGUEZ)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DENNIS RODRIGUEZ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 1ST AVE S
Mailing Address - Street 2:STE 200
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4364
Mailing Address - Country:US
Mailing Address - Phone:407-222-6010
Mailing Address - Fax:
Practice Address - Street 1:5936 GOLDEN PINE CT
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9192
Practice Address - Country:US
Practice Address - Phone:407-222-6010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8450225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation