Healthcare Provider Details

I. General information

NPI: 1407770803
Provider Name (Legal Business Name): GEAN CARLO SEGARRA PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 CALLE DOCTOR SANCHEZ GONZALEZ
ISABELA PR
00662
US

IV. Provider business mailing address

9838 CALLE ENSUENO
ISABELA PR
00662-4831
US

V. Phone/Fax

Practice location:
  • Phone: 787-872-4111
  • Fax:
Mailing address:
  • Phone: 787-455-1240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number4259
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: