Provider Demographics
NPI:1386808707
Name:MICHELLE RODRIGUEZ PT PLLC
Entity type:Organization
Organization Name:MICHELLE RODRIGUEZ PT PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, OCS, CMPT
Authorized Official - Phone:212-247-8436
Mailing Address - Street 1:130 W 56TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3962
Mailing Address - Country:US
Mailing Address - Phone:212-247-8436
Mailing Address - Fax:
Practice Address - Street 1:130 W 56TH ST FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3962
Practice Address - Country:US
Practice Address - Phone:212-247-8436
Practice Address - Fax:212-247-5620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0203092251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty