Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 000935 | PR |
NPI | 1003139015 |
---|---|
Provider Name | Juanita Lopez Ortiz |
First Address | Aguas Buenas, PR 00703-0621 |
Second Address | Aguas Buenas, PR 00703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2010 |
Last Update Date | 05/04/2012 |