Provider Demographics
NPI:1053124529
Name:RODRIGUEZ, MICKI- CRUZ (LMT)
Entity type:Individual
Prefix:MRS
First Name:MICKI-
Middle Name:CRUZ
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:MICKI
Other - Middle Name:CRUZ
Other - Last Name:TREVINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT, TECH
Mailing Address - Street 1:1502 MIDLANE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-3240
Mailing Address - Country:US
Mailing Address - Phone:956-495-0402
Mailing Address - Fax:
Practice Address - Street 1:2213 W LINCOLN ST
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-5921
Practice Address - Country:US
Practice Address - Phone:956-495-0402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT121574225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist