Provider Demographics
NPI:1285081919
Name:RODRIGUEZ, CHRISTOPHER EUGENE (ATC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:EUGENE
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:EUGENE
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:3170 PEBBLE BEACH RD
Mailing Address - Street 2:APT 3
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8552
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-4684
Practice Address - Country:US
Practice Address - Phone:501-831-4929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20000237402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer