Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 0752 | PR |
NPI | 1003151846 |
---|---|
Provider Name | Ilsa Rodriguez |
First Address | San Juan, PR 00926-6514 |
Second Address | San Juan, PR 00926-6514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2012 |
Last Update Date | 05/12/2012 |