Provider Demographics
NPI:1194323246
Name:RODRIGUEZ, RALAWNDA RUTH (PTA)
Entity type:Individual
Prefix:
First Name:RALAWNDA
Middle Name:RUTH
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SE 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-6852
Mailing Address - Country:US
Mailing Address - Phone:918-232-1977
Mailing Address - Fax:
Practice Address - Street 1:1801 FOREST HILLS BLVD STE 205
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715-3071
Practice Address - Country:US
Practice Address - Phone:479-855-9348
Practice Address - Fax:479-855-9358
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist