Provider Demographics
NPI:1700013497
Name:RODRIGUEZ, MAXIMO TIUKINHOY III (RPT)
Entity Type:Individual
Prefix:MR
First Name:MAXIMO
Middle Name:TIUKINHOY
Last Name:RODRIGUEZ
Suffix:III
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-76 QUEENS BOULEVARD
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374
Mailing Address - Country:US
Mailing Address - Phone:718-897-0300
Mailing Address - Fax:718-897-3330
Practice Address - Street 1:98-76 QUEENS BOULEVARD
Practice Address - Street 2:SUITE 1K
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:718-897-0300
Practice Address - Fax:718-897-3330
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029336225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist