Provider Demographics
NPI:1952165912
Name:RODRIGUEZ, KEVIN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 N GRANT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-1602
Mailing Address - Country:US
Mailing Address - Phone:303-482-1540
Mailing Address - Fax:303-482-1545
Practice Address - Street 1:1650 N GRANT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-1602
Practice Address - Country:US
Practice Address - Phone:303-482-1540
Practice Address - Fax:303-482-1545
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0019578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist