Provider Demographics
NPI:1427698620
Name:RODRIGUEZ, ADRIANA ALEXIS (DAT)
Entity type:Individual
Prefix:DR
First Name:ADRIANA
Middle Name:ALEXIS
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 N QUAIL DR
Mailing Address - Street 2:
Mailing Address - City:MARMORA
Mailing Address - State:NJ
Mailing Address - Zip Code:08223-1261
Mailing Address - Country:US
Mailing Address - Phone:609-412-3796
Mailing Address - Fax:
Practice Address - Street 1:701 MILL RD
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-1379
Practice Address - Country:US
Practice Address - Phone:609-383-6900
Practice Address - Fax:609-383-0760
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT002109002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer