Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1443 | PR |
NPI | 1003161241 |
---|---|
Provider Name | Juan Trinidad |
First Address | Trujillo Alto, PR 00976-6088 |
Second Address | San Juan, PR 00926-3145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2012 |
Last Update Date | 04/07/2013 |