Provider Demographics
NPI:1457906273
Name:RODRIGUEZ, MILADY
Entity Type:Individual
Prefix:
First Name:MILADY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9380 SW 72ND ST STE B240
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-5483
Mailing Address - Country:US
Mailing Address - Phone:305-639-8095
Mailing Address - Fax:305-392-0775
Practice Address - Street 1:9380 SW 72ND ST STE B240
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5483
Practice Address - Country:US
Practice Address - Phone:305-639-8095
Practice Address - Fax:305-392-0775
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA87523225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA87523OtherCERTIFIED MASSAGE THERAPIST