Provider Demographics
NPI:1609968247
Name:RODRIGUEZ, ALFONSO EMANUEL F (PT)
Entity Type:Individual
Prefix:
First Name:ALFONSO EMANUEL
Middle Name:F
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 S 12TH ST
Mailing Address - Street 2:SUITE #200
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-3831
Mailing Address - Country:US
Mailing Address - Phone:269-372-7200
Mailing Address - Fax:269-372-1630
Practice Address - Street 1:7901 S 12TH ST
Practice Address - Street 2:SUITE #200
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-3831
Practice Address - Country:US
Practice Address - Phone:269-372-7200
Practice Address - Fax:269-372-1630
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist