Provider Demographics
NPI:1447059977
Name:RODRIGUEZ, ROSA
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8383 WAGNER CT SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-9140
Mailing Address - Country:US
Mailing Address - Phone:541-730-6206
Mailing Address - Fax:
Practice Address - Street 1:30789 SW BOONES FERRY RD STE P
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7842
Practice Address - Country:US
Practice Address - Phone:503-682-6778
Practice Address - Fax:503-682-6744
Is Sole Proprietor?:No
Enumeration Date:2025-03-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28806225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist