Provider Demographics
NPI:1386182293
Name:RODRIGUEZ, RAYMOND ANTHONY (PT, DPT, MAT, ATC)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:ANTHONY
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PT, DPT, MAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7945 YORK ST APT 3
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80229-6152
Mailing Address - Country:US
Mailing Address - Phone:530-386-3884
Mailing Address - Fax:
Practice Address - Street 1:7945 YORK ST APT 3
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80229-6152
Practice Address - Country:US
Practice Address - Phone:530-386-3884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-11
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00021622255A2300X
COPTL.0018854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer