Provider Demographics
NPI:1205392818
Name:RODRIGUEZ, SERGIO A (OTR/L)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10650 CULEBRA RD STE 104-140
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4949
Mailing Address - Country:US
Mailing Address - Phone:210-538-4401
Mailing Address - Fax:
Practice Address - Street 1:1020 CENTRAL PKWY S
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-5021
Practice Address - Country:US
Practice Address - Phone:210-789-2273
Practice Address - Fax:210-495-1479
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119757225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119757OtherLICENSE NUMBER