Healthcare Provider Details

I. General information

NPI: 1255945598
Provider Name (Legal Business Name): JESSICA CARRION PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 04/30/2024
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VIA 16 VILLA FONTANA JR 8
CAROLINA PR
00983
US

IV. Provider business mailing address

CALLE RUFINA CASTILLO 507
LAS PIEDRAS PR
00771
US

V. Phone/Fax

Practice location:
  • Phone: 939-339-6102
  • Fax:
Mailing address:
  • Phone: 787-217-7404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number3076
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3076
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: