Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant |
NPI | 1013444777 |
---|---|
Provider Name | Avery Rodriguez |
First Address | San Antonio, TX 78247-3223 |
Second Address | San Antonio, TX 78238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2017 |
Last Update Date | 12/05/2017 |