Provider Demographics
NPI:1447542204
Name:RODRIGUEZ, ELENA MARIE (DPT)
Entity type:Individual
Prefix:DR
First Name:ELENA
Middle Name:MARIE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20 ALLEN AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2344
Mailing Address - Country:US
Mailing Address - Phone:314-961-3787
Mailing Address - Fax:314-961-0974
Practice Address - Street 1:20 ALLEN AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-2344
Practice Address - Country:US
Practice Address - Phone:314-961-3787
Practice Address - Fax:314-961-0974
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010023077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist