Basic Information
| Provider Information | |||||||||
| NPI: | 1831847250 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | PRISCILLA | ||||||||
| MiddleName: | RENAE | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 N 23RD ST | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785016127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566874560 | ||||||||
| FaxNumber: | 9566181342 | ||||||||
| Practice Location | |||||||||
| Address1: | 7220 LOUIS PASTEUR DR STE 144 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782294534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102909335 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2022 | ||||||||
| LastUpdateDate: | 03/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2151123 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.