Provider Demographics
NPI:1528490133
Name:RODRIGUEZ, ANTHONY JOHN (OT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOHN
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 CORAL WAY STE 202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3053
Mailing Address - Country:US
Mailing Address - Phone:305-283-5659
Mailing Address - Fax:
Practice Address - Street 1:3400 CORAL WAY STE 202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-3053
Practice Address - Country:US
Practice Address - Phone:305-856-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT15902225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009444400Medicaid