Provider Demographics
NPI:1851039143
Name:RODRIGUEZ, DEANNA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
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 1:4250 GLENCOE AVE UNIT 1325
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5685
Mailing Address - Country:US
Mailing Address - Phone:908-377-1502
Mailing Address - Fax:
Practice Address - Street 1:4250 GLENCOE AVE UNIT 1325
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5685
Practice Address - Country:US
Practice Address - Phone:908-377-1502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist