Provider Demographics
NPI:1023488988
Name:RODRIGUEZ, CHRISTANIE (MS, ATC, LAT)
Entity type:Individual
Prefix:
First Name:CHRISTANIE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 TAFT BLVD
Mailing Address - Street 2:D.L LIGON COLISEUM 158
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2036
Mailing Address - Country:US
Mailing Address - Phone:940-397-4815
Mailing Address - Fax:940-397-4901
Practice Address - Street 1:3410 TAFT BLVD
Practice Address - Street 2:D.L LIGON COLISEUM 158
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2036
Practice Address - Country:US
Practice Address - Phone:940-397-4815
Practice Address - Fax:940-397-4901
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-03
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT44932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer