Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 63.001639 | CT |
NPI | 1003272493 |
---|---|
Provider Name | Destiny Rodriguez |
First Address | Beacon Falls, CT 06403-4909 |
Second Address | Naugatuck, CT 06770-4706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2016 |
Last Update Date | 14/01/2016 |