Provider Demographics
NPI:1922285758
Name:RODRIGUEZ, STACY RACHELLE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:RACHELLE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 N STATE ROAD 7 STE A
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-5184
Mailing Address - Country:US
Mailing Address - Phone:561-784-3767
Mailing Address - Fax:561-784-9346
Practice Address - Street 1:1011 N STATE ROAD 7 STE A
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-5184
Practice Address - Country:US
Practice Address - Phone:561-784-3767
Practice Address - Fax:561-784-9346
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106517AMedicare PIN