Provider Demographics
NPI:1912026550
Name:RODRIGUEZ, SEIDY (RPT)
Entity Type:Individual
Prefix:
First Name:SEIDY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CONNOLLY PKWY
Mailing Address - Street 2:BLDG.17
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2593
Mailing Address - Country:US
Mailing Address - Phone:203-230-2815
Mailing Address - Fax:203-230-8502
Practice Address - Street 1:60 CONNOLLY PKWY
Practice Address - Street 2:BLDG.17
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2593
Practice Address - Country:US
Practice Address - Phone:203-230-2815
Practice Address - Fax:203-230-8502
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003938OtherLICENSE #