Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 1125 | PR |
NPI | 1467402354 |
---|---|
Provider Name | Dr. Luis Antonio Lizardi Ramirez |
First Address | Carolina, PR 00985-4006 |
Second Address | Carolina, PR 00985 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 23/03/2016 |