MEDICARE: MRS. MADELINE SOTO PT437

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	437	PR

General Provider Information

NPI Number	:	1134436512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MADELINE SOTO PT437

Provider Business Mailing Address
First Line	:	155 CALLE HIGUERO
Second Line	:	LOS FLAMBOYANES
City	:	GURABO
State	:	PR
Zip	:	00778-2768
Country	:	US
Telephone Number	:	787-637-1461
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 CALLE HIGUERO
Second Line	:	LOS FLAMBOYANES
City	:	GURABO
State	:	PR
Zip	:	00778-2768
Country	:	US
Telephone Number	:	787-637-1461
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2010
Last Update Date	:	06/23/2011

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