Provider Demographics
NPI:1184810335
Name:RODRIGUEZ, RALPH ANTHONY (PT)
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:ANTHONY
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4120 HERITAGE TRACE PKWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-1308
Mailing Address - Country:US
Mailing Address - Phone:817-741-7585
Mailing Address - Fax:817-741-7587
Practice Address - Street 1:4120 HERITAGE TRACE PARKWAY
Practice Address - Street 2:SUITE 220
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248
Practice Address - Country:US
Practice Address - Phone:817-741-7585
Practice Address - Fax:817-741-7587
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1174430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist