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General NPI Number Information
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NPI Number | 1215265202
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Entity Type | Individual
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Provider Name | ADA I COLON-GAVILLAN PT,MPT
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Gender | Female
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Dates
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Enumeration Date | 12/02/2009
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Last Update Date | 12/02/2009
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Provider Practice Location Address
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Address Line | VILLA CAROLINA 104-17 104STREET
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City | CAROLINA
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State | PR
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Zip | 00985
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Country | US
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Telephone | 787-752-0869
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 9030
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City | HUMACAO
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State | PR
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Zip | 00792-9030
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Country | US
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Telephone | 787-585-3610
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 776
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License Number State | PR
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