Provider Demographics
NPI:1477826717
Name:RODRIGO, MICHAEL TOM IZAR
Entity type:Individual
Prefix:MR
First Name:MICHAEL TOM
Middle Name:IZAR
Last Name:RODRIGO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2494 ROYALANN LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-9237
Mailing Address - Country:US
Mailing Address - Phone:541-905-7016
Mailing Address - Fax:
Practice Address - Street 1:2494 ROYALANN LN
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-9237
Practice Address - Country:US
Practice Address - Phone:541-905-7016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6764225100000X
FLPT 27174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist