Basic Information
| Provider Information | |||||||||
| NPI: | 1154649283 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PT, DPT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MCBRIDE | ||||||||
| OtherFirstName: | HEATHER | ||||||||
| OtherMiddleName: | L | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 962500 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799962500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9158496602 | ||||||||
| FaxNumber: | 9158496603 | ||||||||
| Practice Location | |||||||||
| Address1: | 11351 JAMES WATT DR | ||||||||
| Address2: | STE. A | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799366627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9158496602 | ||||||||
| FaxNumber: | 9158496603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2010 | ||||||||
| LastUpdateDate: | 04/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1188865 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.