Provider Demographics
NPI:1548313661
Name:RODRIGUEZ, KATHLEEN MARIE (PT)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARIE
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 1:153 RESEARCH RD
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1762
Mailing Address - Country:US
Mailing Address - Phone:301-257-9373
Mailing Address - Fax:
Practice Address - Street 1:12122 HERITAGE PARK CIR # A
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-4554
Practice Address - Country:US
Practice Address - Phone:301-942-6006
Practice Address - Fax:301-942-4513
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14423174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA690PE A692KMOtherCAREFIRST BCBS
MDS958 002OtherBSBC FEP PLAN