Provider Demographics
NPI:1154755312
Name:FLORES, RODOLFO JR (OTR)
Entity type:Individual
Prefix:
First Name:RODOLFO
Middle Name:
Last Name:FLORES
Suffix:JR
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:RUDY
Other - Middle Name:
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR
Mailing Address - Street 1:PO BOX 227214
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75222-7214
Mailing Address - Country:US
Mailing Address - Phone:214-458-3454
Mailing Address - Fax:214-634-3475
Practice Address - Street 1:4441 W AIRPORT FWY STE 240
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-5960
Practice Address - Country:US
Practice Address - Phone:214-458-3454
Practice Address - Fax:214-634-3475
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110382225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110382OtherTEXAS BOARD OF OCCUPATIONAL THERAPY