MEDICARE: NIZETTE I CORDERO 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	871	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	89222	OTHER	PR	TRIPLE-S (REFORMA)

General Provider Information

NPI Number	:	1760480180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIZETTE I CORDERO RPT

Provider Business Mailing Address
First Line	:	REPARTO MARQUEZ
Second Line	:	CALLE 9 G-26
City	:	ARECIBO
State	:	PR
Zip	:	00612-0000
Country	:	US
Telephone Number	:	787-898-5885
Fax Number	:	787-898-5885

Provider Business Practice Location Address
First Line	:	CARR. 129 KM 13.6
Second Line	:	BO. BAYANEY
City	:	HATILLO
State	:	PR
Zip	:	00659-0000
Country	:	US
Telephone Number	:	787-898-5885
Fax Number	:	787-898-5885

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

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	12/15/2007

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Directions to “ NIZETTE I CORDERO RPT” Practice Location

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