Provider Demographics
NPI:1386865806
Name:RODRIGUEZ, STEPHEN ERIC (PT)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ERIC
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-0129
Mailing Address - Country:US
Mailing Address - Phone:845-786-4177
Mailing Address - Fax:845-786-4031
Practice Address - Street 1:51 S ROUTE 9W
Practice Address - Street 2:
Practice Address - City:WEST HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993-1055
Practice Address - Country:US
Practice Address - Phone:845-786-4177
Practice Address - Fax:845-786-4031
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022896-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic