Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 5501018370 | MI |
NPI | 1093218810 |
---|---|
Provider Name | Ashley Nicole Rodriguez |
First Address | Grand Rapids, MI 49508-1533 |
Second Address | Grand Rapids, MI 49508-7910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2018 |
Last Update Date | 18/03/2018 |