Healthcare Provider Details

I. General information

NPI: 1285543579
Provider Name (Legal Business Name): JIZZYAN MARIE GESUALDO PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. TITO CASTRO 917 BUILDING A FLOOR 4
PONCE PR
00732-7064
US

IV. Provider business mailing address

HACIENDA LA MATILDE 5128 TRAPICHE
PONCE PR
00728-2425
US

V. Phone/Fax

Practice location:
  • Phone: 787-601-1465
  • Fax:
Mailing address:
  • Phone: 787-601-1465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004692
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: