Provider Demographics
NPI:1730537283
Name:RODOCKER, DAVID HENRY (ATC, LAT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:HENRY
Last Name:RODOCKER
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 S LOOP 499 APT R6
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-2503
Mailing Address - Country:US
Mailing Address - Phone:918-704-8010
Mailing Address - Fax:
Practice Address - Street 1:450 S WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-3308
Practice Address - Country:US
Practice Address - Phone:956-361-6593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT59922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer