MEDICARE: MRS. CARMEN S VAZQUEZ RIVERA RPT

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	00708	PR

General Provider Information

NPI Number	:	1184633042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARMEN S VAZQUEZ RIVERA RPT

Provider Business Mailing Address
First Line	:	HC - 4 BOX 42414
Second Line	:
City	:	MOROVIS
State	:	PR
Zip	:	00687-7025
Country	:	US
Telephone Number	:	787-854-0165
Fax Number	:	787-854-0165

Provider Business Practice Location Address
First Line	:	STREET 3 D-15 FLAMBOYAN URB.
Second Line	:	OHARRIZ BLDG SUITE 2
City	:	MANATI
State	:	PR
Zip	:	00674-0000
Country	:	US
Telephone Number	:	787-854-0165
Fax Number	:	787-854-0165

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	08/12/2009

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Directions to “ MRS. CARMEN S VAZQUEZ RIVERA RPT” Practice Location

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