Provider Demographics
NPI:1821618869
Name:RODAS, LUIS DARIEL (ATC)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:DARIEL
Last Name:RODAS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6220 SHALLOWFORD RD APT 519
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-6906
Mailing Address - Country:US
Mailing Address - Phone:615-482-4470
Mailing Address - Fax:
Practice Address - Street 1:4650 BUCCANEER TRL
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-1247
Practice Address - Country:US
Practice Address - Phone:617-742-3622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer