Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT33198 | FL |
N | 2251S0007X | Physical Therapist - Sports |
NPI | 1114430501 |
---|---|
Provider Name | Peter R Rodriguez |
First Address | Miami, FL 33143-3753 |
Second Address | Miami, FL 33143-3753 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2017 |
Last Update Date | 08/11/2017 |