Provider Demographics
NPI:1841803640
Name:RODRIGUEZ, RAFAEL JR (DPT)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:RODRIGUEZ
Suffix:JR
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 1:1413 VISCAYA PKWY
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-6206
Mailing Address - Country:US
Mailing Address - Phone:239-242-0070
Mailing Address - Fax:239-242-0076
Practice Address - Street 1:1413 VISCAYA PKWY
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-6206
Practice Address - Country:US
Practice Address - Phone:239-242-0070
Practice Address - Fax:239-242-0076
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT35873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty