Provider Demographics
NPI:1174533848
Name:RODRIGUEZ, JR, CARLOS C (LPT, CHT)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:C
Last Name:RODRIGUEZ, JR
Suffix:
Gender:M
Credentials:LPT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2390 CENTRAL BLVD
Mailing Address - Street 2:SUITE Q
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520
Mailing Address - Country:US
Mailing Address - Phone:956-544-6467
Mailing Address - Fax:956-544-2556
Practice Address - Street 1:2390 CENTRAL BLVD STE Q
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8717
Practice Address - Country:US
Practice Address - Phone:956-544-6467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10239192251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX650448Medicare ID - Type Unspecified