Provider Demographics
NPI:1942542642
Name:RODRIGUEZ, CAROLYN PLOU (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:PLOU
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 1:6358 OAKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2150
Mailing Address - Country:US
Mailing Address - Phone:714-785-6325
Mailing Address - Fax:
Practice Address - Street 1:6358 OAKRIDGE RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-2150
Practice Address - Country:US
Practice Address - Phone:714-785-6325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist