Provider Demographics
NPI:1396066486
Name:RODRIGUEZ, ARSENIO A (MSPT)
Entity type:Individual
Prefix:
First Name:ARSENIO
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 STEPHENS PARK RD
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-5007
Mailing Address - Country:US
Mailing Address - Phone:973-652-7456
Mailing Address - Fax:862-258-3134
Practice Address - Street 1:190 STEPHENS PARK RD
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-5007
Practice Address - Country:US
Practice Address - Phone:973-652-7456
Practice Address - Fax:862-258-3134
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-12
Last Update Date:2010-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA10027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist