Healthcare Provider Details

I. General information

NPI: 1366351678
Provider Name (Legal Business Name): LISBETH TAMARA RENTAS RODRIGUEZ PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

869 AVE MUNOZ RIVERA # E101
RIO PIEDRAS PR
00925-2103
US

IV. Provider business mailing address

1484 AVE FD ROOSEVELT
SAN JUAN PR
00920-2029
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-7370
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1453
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: