Provider Demographics
NPI:1659595627
Name:RODRIGUEZ, EDWARD K (PT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:K
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 1:1 CORBETT WAY
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2264
Mailing Address - Country:US
Mailing Address - Phone:732-542-8818
Mailing Address - Fax:732-389-6595
Practice Address - Street 1:1 CORBETT WAY
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2264
Practice Address - Country:US
Practice Address - Phone:732-542-8818
Practice Address - Fax:732-389-6595
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01005500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ063003PL9Medicare ID - Type Unspecified