Provider Demographics
NPI:1669764171
Name:RODRIGUEZ, BEVERLY BEBE (PTA)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:BEBE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7250 SW HARBOR COVE DR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7400
Mailing Address - Country:US
Mailing Address - Phone:772-403-3293
Mailing Address - Fax:
Practice Address - Street 1:1500 PALM BEACH RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4044
Practice Address - Country:US
Practice Address - Phone:772-288-1860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA14238225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA14238OtherPTA