1497890537 NPI number — MISS CARMEN I. MORENO CRESPO PHYSICAL THERAPIST

Table of content: MISS CARMEN I. MORENO CRESPO PHYSICAL THERAPIST (NPI 1497890537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497890537 NPI number — MISS CARMEN I. MORENO CRESPO PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORENO CRESPO
Provider First Name:
CARMEN
Provider Middle Name:
I.
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497890537
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1066
Provider Second Line Business Mailing Address:
EDIF. LAS VEGAS #420, BO CAMPO ALEGRE
Provider Business Mailing Address City Name:
MANATI
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00674-1066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-854-1426
Provider Business Mailing Address Fax Number:
787-884-3757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EDIF. LAS VEGAS #420, BO CAMPO ALEGRE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANATI
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00674-1086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-854-1426
Provider Business Practice Location Address Fax Number:
787-884-3757
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1240 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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