Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT32151 | FL |
N | 225700000X | Massage Therapist | MA50849 | FL |
NPI | 1053824680 |
---|---|
Provider Name | Miss Christine Rodriguez |
First Address | Saint Augustine, FL 32080-6833 |
Second Address | Saint Augustine, FL 32086-5300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2017 |
Last Update Date | 17/03/2018 |