Individual
MARISA PILAR RODDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
5006 COPPER AVE NE, ALBUQUERQUE, NM 87108-1301
(505) 268-7988
(505) 268-8021
Mailing address
5006 COPPER AVE NE, ALBUQUERQUE, NM 87108-1301
(505) 328-1734
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
4197
NM
2251X0800X
Orthopedic Physical Therapist
4197
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10171568
—
NM
01
—
326556
FACILITY MEDICARE
NM
Enumeration date
09/17/2012
Last updated
03/06/2017
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