Provider Demographics
NPI:1538238688
Name:RODRIGUEZ, CLARA (PT)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W INDIANTOWN RD STE 104
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3539
Mailing Address - Country:US
Mailing Address - Phone:561-745-8909
Mailing Address - Fax:561-748-7199
Practice Address - Street 1:125 W INDIANTOWN RD STE 104
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3539
Practice Address - Country:US
Practice Address - Phone:561-745-8909
Practice Address - Fax:561-748-7199
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY902CMedicare ID - Type Unspecified