Provider Demographics
NPI:1245427426
Name:RODRIGUEZ, ANGELA MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:5725 NE 31ST TER
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34479-6841
Mailing Address - Country:US
Mailing Address - Phone:352-369-1781
Mailing Address - Fax:352-369-1781
Practice Address - Street 1:5725 NE 31ST TER
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34479-6841
Practice Address - Country:US
Practice Address - Phone:352-369-1781
Practice Address - Fax:352-369-1781
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10436225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1245427426Medicare PIN