Provider Demographics
NPI:1588461115
Name:RODRIGUEZ, MADISON (PTA)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:NASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:6210 CORD GRASS LN
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29906-6101
Mailing Address - Country:US
Mailing Address - Phone:760-646-7291
Mailing Address - Fax:
Practice Address - Street 1:6210 CORD GRASS LN
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-6101
Practice Address - Country:US
Practice Address - Phone:760-646-7291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6718225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant