Provider Demographics
NPI:1972796035
Name:RODRIGUEZ, MARIELYS (MPT)
Entity type:Individual
Prefix:MISS
First Name:MARIELYS
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C VISTA DEL MAR #168 BAYAMON
Mailing Address - Street 2:PANORAMA VILLAGE
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-799-4061
Mailing Address - Fax:787-799-4061
Practice Address - Street 1:168 VISTA DEL MAR
Practice Address - Street 2:PANORAMA VILLAGE
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-4406
Practice Address - Country:US
Practice Address - Phone:787-799-4061
Practice Address - Fax:787-799-4061
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist