Provider Demographics
NPI:1922445501
Name:RODRUGUEZ RIVERA, DENISE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:RODRUGUEZ RIVERA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311NW110TH AVE
Mailing Address - Street 2:UNIT S
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-7723
Mailing Address - Country:US
Mailing Address - Phone:954-753-4501
Mailing Address - Fax:
Practice Address - Street 1:4311NW110TH AVE
Practice Address - Street 2:UNIT S
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-7723
Practice Address - Country:US
Practice Address - Phone:954-753-4501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA66845225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist