Provider Demographics
NPI:1588983316
Name:RODRIGUEZ, LEIA KIRSTEN (MPT)
Entity type:Individual
Prefix:
First Name:LEIA
Middle Name:KIRSTEN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:LEIA
Other - Middle Name:KIRSTEN
Other - Last Name:LARSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2217 SUNSET BLVD
Mailing Address - Street 2:SUITE 711
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4781
Mailing Address - Country:US
Mailing Address - Phone:916-435-3500
Mailing Address - Fax:916-435-3503
Practice Address - Street 1:2217 SUNSET BLVD
Practice Address - Street 2:SUITE 711
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4781
Practice Address - Country:US
Practice Address - Phone:916-435-3500
Practice Address - Fax:916-435-3503
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36702225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist