MEDICARE: MRS. CARMEN ROSAURA ORTIZ-RODRIGUEZ PT

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	556	PR

General Provider Information

NPI Number	:	1386891703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARMEN ROSAURA ORTIZ-RODRIGUEZ PT

Provider Business Mailing Address
First Line	:	G226 CALLE FILADELFIA
Second Line	:	ROLLING HILLS
City	:	CAROLINA
State	:	PR
Zip	:	00987-7016
Country	:	US
Telephone Number	:	787-532-2524
Fax Number	:

Provider Business Practice Location Address
First Line	:	G226 CALLE FILADELFIA
Second Line	:	ROLLING HILLS
City	:	CAROLINA
State	:	PR
Zip	:	00987-7016
Country	:	US
Telephone Number	:	787-532-2524
Fax Number	:

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

Provider Enumeration Date	:	08/27/2008
Last Update Date	:	06/07/2010

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