Healthcare Provider Details

I. General information

NPI: 1346517232
Provider Name (Legal Business Name): YOMAYRA BERRIOS LOPEZ MS, RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE SANCHEZ VILELLA GO-5 COUNTRY CLUB
CAROLINA PR
00983
US

IV. Provider business mailing address

CONDOMINIO PARQUE ARCOIRIS CALLE 2 #227 APARTAMENTO F-365
TRUJILLO ALTO PR
00976
US

V. Phone/Fax

Practice location:
  • Phone: 787-762-3572
  • Fax: 787-762-3572
Mailing address:
  • Phone: 787-598-2333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1378
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: