Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 000217 | PR |
N | 226300000X | Kinesiotherapist | 000217 | PR |
NPI | 1811494438 |
---|---|
Provider Name | Mr. Daniel Berrios Bones |
First Address | San Juan, PR 00919-1147 |
Second Address | San Juan, PR 00927-6310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2018 |
Last Update Date | 10/04/2018 |