Provider Demographics
NPI:1346071941
Name:RODRIGUEZ, SERGIO (DPT)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4758 LOMA DEL SUR DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3597
Mailing Address - Country:US
Mailing Address - Phone:915-755-0738
Mailing Address - Fax:915-755-6941
Practice Address - Street 1:13472 EASTLAKE BLVD
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-6320
Practice Address - Country:US
Practice Address - Phone:915-285-0943
Practice Address - Fax:915-593-5187
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1398160225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist