Provider Demographics
NPI:1760514905
Name:RODRIGUEZ, KELLE HAGEL (PT)
Entity Type:Individual
Prefix:MRS
First Name:KELLE
Middle Name:HAGEL
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3637 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-8182
Mailing Address - Country:US
Mailing Address - Phone:830-990-0291
Mailing Address - Fax:830-997-3786
Practice Address - Street 1:712 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-3134
Practice Address - Country:US
Practice Address - Phone:830-997-3781
Practice Address - Fax:830-997-3786
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1072932225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist