Most Relevant Information
Provider Data
| NPI Number: | 1003570862 |
| Provider Name: | MATTHEW C RODRIGUE ATC, LAT, MA |
| Entity Type: | Individual |
| Taxonomy Code: | 2255A2300X |
| Specialty: | Specialist/Technologist |
| License Number: | ATH.200172 |
Most Important Dates
| Enumeration Date: | 10/27/2021 |
| Last Updated: | 07/15/2022 |
Provider Practice Location
2030 14TH ST BLDG 1830
FORT POLK
LA
714595302
Practice Location Phone/Fax
| Phone: | 5044150392 |
| Fax: |
Provider Mailing Location
136 COLONY STATION ST
THIBODAUX
LA
703011100
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |