Provider Demographics
NPI:1740707819
Name:RODRIGUEZ, DAVID (DPT)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
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 1:11815 VANCE JACKSON RD APT 401
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1455
Mailing Address - Country:US
Mailing Address - Phone:210-778-6303
Mailing Address - Fax:
Practice Address - Street 1:1004 MISSION DR
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6129
Practice Address - Country:US
Practice Address - Phone:830-625-8338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1267906225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist