Provider Demographics
NPI:1285065466
Name:RODRIGUES, WAYNE (ATC, EMT-P)
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:
Last Name:RODRIGUES
Suffix:
Gender:M
Credentials:ATC, EMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 ALDEN STREET
Mailing Address - Street 2:SPRINGFIELD COLLEGE
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01109-3707
Mailing Address - Country:US
Mailing Address - Phone:413-748-3188
Mailing Address - Fax:413-748-3817
Practice Address - Street 1:263 ALDEN STREET
Practice Address - Street 2:SPRINGFIELD COLLEGE
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109
Practice Address - Country:US
Practice Address - Phone:413-748-3188
Practice Address - Fax:413-748-3817
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer