Healthcare Provider Details

I. General information

NPI: 1134155997
Provider Name (Legal Business Name): SANDRA ROSADO PENA PT, MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27-16 AVE ROBERTO CLEMENTE
CAROLINA PR
00985-5420
US

IV. Provider business mailing address

VILLAS DE PARQUE ESCORIAL APT. 706
CAROLINA PR
00987-4828
US

V. Phone/Fax

Practice location:
  • Phone: 787-276-8123
  • Fax: 787-957-2478
Mailing address:
  • Phone: 787-649-8007
  • Fax: 787-957-2478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number00948
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: