Provider Demographics
NPI:1730282765
Name:RODRIGUEZ, MELINDA AGPAOA (PT,DPT)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:AGPAOA
Last Name:RODRIGUEZ
Suffix:
Gender:F
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 1:23702 JENKINS HILL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-9539
Mailing Address - Country:US
Mailing Address - Phone:210-724-4296
Mailing Address - Fax:210-349-0097
Practice Address - Street 1:1314 E. SONTERRA BLVD.
Practice Address - Street 2:SUITE 601
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4291
Practice Address - Country:US
Practice Address - Phone:210-724-4296
Practice Address - Fax:210-349-0097
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2010-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1069730225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
613628OtherMEDICARE PROVIDER NUMBER