Provider Demographics
NPI:1114757937
Name:RODRIGUES, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:RODRIGUES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 MOUNTAIN AVE STE 122
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-3434
Mailing Address - Country:US
Mailing Address - Phone:973-938-4100
Mailing Address - Fax:973-949-6144
Practice Address - Street 1:871 MOUNTAIN AVE STE 122
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-3434
Practice Address - Country:US
Practice Address - Phone:973-938-4100
Practice Address - Fax:973-949-6144
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02266800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist