Provider Demographics
NPI:1477881704
Name:RODRIGUEZ, MARY ANGELICA DAMIAN (PT)
Entity type:Individual
Prefix:MS
First Name:MARY ANGELICA
Middle Name:DAMIAN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 OLD SPRINGVILLE RD
Mailing Address - Street 2:SUITE104
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-5858
Mailing Address - Country:US
Mailing Address - Phone:205-520-9600
Mailing Address - Fax:205-528-0455
Practice Address - Street 1:1920 OLD SPRINGVILLE RD
Practice Address - Street 2:SUITE104
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-5858
Practice Address - Country:US
Practice Address - Phone:205-520-9600
Practice Address - Fax:205-528-0455
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017321225100000X
NY0307841225100000X
CT008679225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0307841OtherPHYSICAL THERAPY NEW YORK LICENSE NUMBER