Provider Demographics
NPI:1710338710
Name:RODRIGUEZ, BRIAN (DPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:630-928-5040
Practice Address - Street 1:800 DEVON AVE
Practice Address - Street 2:UNIT B
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4760
Practice Address - Country:US
Practice Address - Phone:847-292-4710
Practice Address - Fax:847-292-4903
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070022719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist