Provider Demographics
NPI:1245359488
Name:RODRIGUEZ, MAYRA ALEJANDRA (ATC, LAT)
Entity type:Individual
Prefix:MS
First Name:MAYRA
Middle Name:ALEJANDRA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1872 NORTH HIGHWAY 83
Mailing Address - Street 2:APARTMENT 4
Mailing Address - City:ROMA
Mailing Address - State:TX
Mailing Address - Zip Code:78584
Mailing Address - Country:US
Mailing Address - Phone:806-681-8663
Mailing Address - Fax:
Practice Address - Street 1:2021 N HWY 83
Practice Address - Street 2:
Practice Address - City:ROMA
Practice Address - State:TX
Practice Address - Zip Code:78584-0934
Practice Address - Country:US
Practice Address - Phone:806-681-8663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT28262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer