Healthcare Provider Details

I. General information

NPI: 1518241389
Provider Name (Legal Business Name): ROSAMARIA MONTENEGRO PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 9 D-33 URBANIZACION VALPARAISO
TOA BAJA PR
00949-4037
US

IV. Provider business mailing address

CRISANTEMO IG-2 ROYAL PALM URB ROYAL PALM
BAYAMON PR
00956-3111
US

V. Phone/Fax

Practice location:
  • Phone: 787-366-1401
  • Fax:
Mailing address:
  • Phone: 787-366-1401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1414
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: