Basic Information
| Provider Information | |||||||||
| NPI: | 1003942988 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 157 SHELTER ROCK RD UNIT 8 | ||||||||
| Address2: | |||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068107067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037970073 | ||||||||
| FaxNumber: | 2032649251 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 POMPERAUG OFFICE PARK | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | SOUTHBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064882288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032641735 | ||||||||
| FaxNumber: | 2032649251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 000353 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.