Provider Demographics
NPI:1447922570
Name:RODRIQUEZ, KASEY
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:RODRIQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 CONCRETE RD
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:KY
Mailing Address - Zip Code:40311-9721
Mailing Address - Country:US
Mailing Address - Phone:859-289-3492
Mailing Address - Fax:
Practice Address - Street 1:2323 CONCRETE RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:KY
Practice Address - Zip Code:40311-9721
Practice Address - Country:US
Practice Address - Phone:859-289-3492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA03520225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant