Healthcare Provider Details

I. General information

NPI: 1265678429
Provider Name (Legal Business Name): JOSENY VERDEJO RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 AVE. PONCE DE LEON, EDIF, SANTA ANA
SAN JUAN PR
00907
US

IV. Provider business mailing address

PO BOX 79691
CAROLINA PR
00984-9691
US

V. Phone/Fax

Practice location:
  • Phone: 787-723-8784
  • Fax:
Mailing address:
  • Phone: 787-723-8784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1290
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: