Individual
JUAN CHANELO RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
6619 1ST AVE S, ST PETERSBURG, FL 33707-1305
(727) 623-9996
Mailing address
9943 14TH ST N APT 204, SAINT PETERSBURG, FL 33716-5019
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
MA75384
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA75384
LMT
FL
Enumeration date
03/03/2021
Last updated
03/03/2021
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