Provider Demographics
NPI:1548815244
Name:RODRIGUEZ, ANTHONY (LAT ATC)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:LAT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 SOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-2340
Mailing Address - Country:US
Mailing Address - Phone:215-338-9494
Mailing Address - Fax:
Practice Address - Street 1:3301 SOLLY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-2340
Practice Address - Country:US
Practice Address - Phone:215-338-9494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0046242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer