Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2147209 | TX |
NPI | 1013566728 |
---|---|
Provider Name | Carlos David Rodriguez |
First Address | Laredo, TX 78041-6473 |
Second Address | Laredo, TX 78041-6473 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2019 |
Last Update Date | 07/09/2020 |