Provider Demographics
NPI:1427810878
Name:RODRIGUEZ, GABRIELLA
Entity type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2133 STAGHORN WAY
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-4873
Mailing Address - Country:US
Mailing Address - Phone:614-806-7638
Mailing Address - Fax:
Practice Address - Street 1:225 RATHMELL RD
Practice Address - Street 2:
Practice Address - City:LOCKBOURNE
Practice Address - State:OH
Practice Address - Zip Code:43137-9324
Practice Address - Country:US
Practice Address - Phone:513-502-5474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0058162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer