Provider Demographics
NPI:1053004382
Name:RODRIGUEZ, JOHN-ANTHONY (LMT)
Entity type:Individual
Prefix:
First Name:JOHN-ANTHONY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10613 PRINCETON ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-5115
Mailing Address - Country:US
Mailing Address - Phone:201-310-6989
Mailing Address - Fax:
Practice Address - Street 1:10613 PRINCETON ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-5115
Practice Address - Country:US
Practice Address - Phone:201-310-6989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028303-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist