Provider Demographics
NPI:1043484470
Name:ANDRADE, RODRIGO ANDRES (PT)
Entity type:Individual
Prefix:
First Name:RODRIGO
Middle Name:ANDRES
Last Name:ANDRADE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9456 SW 77TH AVE
Mailing Address - Street 2:APT T8
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2733
Mailing Address - Country:US
Mailing Address - Phone:305-898-6874
Mailing Address - Fax:305-242-9442
Practice Address - Street 1:9456 SW 77TH AVE
Practice Address - Street 2:APT T8
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-2733
Practice Address - Country:US
Practice Address - Phone:305-898-6874
Practice Address - Fax:305-242-9442
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist