Healthcare Provider Details

I. General information

NPI: 1487209680
Provider Name (Legal Business Name): RAYMOND MARRERO DPT, PT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAYA AZUL CENTER LOCAL #4 CARR.193 KM 1.0
LUQUILLO PR
00773-0077
US

IV. Provider business mailing address

HC 3 BOX 7662
CANOVANAS PR
00729-9715
US

V. Phone/Fax

Practice location:
  • Phone: 787-889-6012
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4697
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: