Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 07305 | MD |
NPI | 1124668272 |
---|---|
Provider Name | Joshua Rodriguez |
First Address | Pikesville, MD 21208-1381 |
Second Address | Pikesville, MD 21208-1381 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2020 |
Last Update Date | 07/01/2020 |