MEDICARE: MABEL CEDRES P.T.

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	377	PR

General Provider Information

NPI Number	:	1487761946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MABEL CEDRES P.T.

Provider Business Mailing Address
First Line	:	URB. EL CEREZAL 1614 LOIRA ST.
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926-3034
Country	:	US
Telephone Number	:	787-767-6378
Fax Number	:	787-767-6378

Provider Business Practice Location Address
First Line	:	URB. EL CEREZAL 1614 LOIRA ST.
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926-3034
Country	:	US
Telephone Number	:	787-767-6378
Fax Number	:	787-767-6378

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	09/05/2008

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