Provider Demographics
NPI:1417830753
Name:RODRIGUEZ, ADRIAN JEREMY (PTA)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:JEREMY
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6106 RIVERCHASE TRL
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345-2133
Mailing Address - Country:US
Mailing Address - Phone:832-492-7517
Mailing Address - Fax:
Practice Address - Street 1:9250 HUMBLE WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4247
Practice Address - Country:US
Practice Address - Phone:281-446-5160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2187824225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant