Provider Demographics
NPI:1144569476
Name:RODRIGUE, ANDREA IRENE (PTA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:IRENE
Last Name:RODRIGUE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3848 LEXMARK LN
Mailing Address - Street 2:UNIT 206
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5223
Mailing Address - Country:US
Mailing Address - Phone:321-271-4221
Mailing Address - Fax:
Practice Address - Street 1:1310 37TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4860
Practice Address - Country:US
Practice Address - Phone:772-778-1408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 20559225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant