Provider Demographics
NPI:1841545688
Name:RODRIGUES, NATALIE B (PT, DPT, CLT)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:B
Last Name:RODRIGUES
Suffix:
Gender:F
Credentials:PT, DPT, CLT
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:TALIA
Other - Last Name:BACCILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1014
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1014
Mailing Address - Country:US
Mailing Address - Phone:732-855-9751
Mailing Address - Fax:732-855-9755
Practice Address - Street 1:24-17 FAIR LAWN AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3429
Practice Address - Country:US
Practice Address - Phone:201-794-4417
Practice Address - Fax:201-794-4419
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01448200174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist