Provider Demographics
NPI:1285948240
Name:RODRIGUEZ, REGINA MARIE (CMT)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 UNIVERSITY BLVD
Mailing Address - Street 2:#206
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4657
Mailing Address - Country:US
Mailing Address - Phone:303-839-1993
Mailing Address - Fax:
Practice Address - Street 1:201 UNIVERSITY BLVD
Practice Address - Street 2:#206
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4657
Practice Address - Country:US
Practice Address - Phone:303-839-1993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 174H00000X, 225400000X
CO8753225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist
No174H00000XOther Service ProvidersHealth Educator
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO8753OtherDORA