Healthcare Provider Details

I. General information

NPI: 1003835307
Provider Name (Legal Business Name): JUAN CARLOS ROQUE-MARTINEZ PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

YY43 CALLE 49 JARDINES DEL CARIBE
PONCE PR
00728-2654
US

IV. Provider business mailing address

49TH STREET # YY-43 JARDINES DEL CARIBE
PONCE PR
00728-4438
US

V. Phone/Fax

Practice location:
  • Phone: 787-812-3030
  • Fax: 787-651-4306
Mailing address:
  • Phone: 787-812-3030
  • Fax: 787-651-4306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number900
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: