Provider Demographics
NPI:1093578932
Name:RODRIGUE, REGINAL
Entity type:Individual
Prefix:
First Name:REGINAL
Middle Name:
Last Name:RODRIGUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#560 CALLE NAPOLES, CONCORDIA GARDEN II,APTO 16L, SAN J
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:178-740-4863
Mailing Address - Fax:
Practice Address - Street 1:#560 CALLE NAPOLES, CONCORDIA GARDEN II,APTO 16L, SAN J
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:178-740-4863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant