Provider Demographics
NPI:1700594371
Name:RODRIGUEZ, EMMITT ENRIQUE (DPT)
Entity Type:Individual
Prefix:
First Name:EMMITT
Middle Name:ENRIQUE
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 AIRPORT FWY STE U
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6783
Mailing Address - Country:US
Mailing Address - Phone:817-858-0390
Mailing Address - Fax:817-858-0842
Practice Address - Street 1:1424 AIRPORT FWY STE U
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6783
Practice Address - Country:US
Practice Address - Phone:817-858-0390
Practice Address - Fax:817-858-0842
Is Sole Proprietor?:No
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1369764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist