Provider Demographics
NPI:1639922321
Name:RODRIGUEZ, JUAN CARLOS INQUIMBOY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JUAN CARLOS
Middle Name:INQUIMBOY
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 1:408 TURNER CT APT 81B
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2346
Mailing Address - Country:US
Mailing Address - Phone:910-870-5511
Mailing Address - Fax:
Practice Address - Street 1:700 JOHNSON RIDGE RD
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2424
Practice Address - Country:US
Practice Address - Phone:336-527-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist