MEDICARE: ELSIE MEDINA 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	856	PR

General Provider Information

NPI Number	:	1770582827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELSIE MEDINA P.T.

Provider Business Mailing Address
First Line	:	PO BOX 467
Second Line	:
City	:	TOA ALTA
State	:	PR
Zip	:	00954-0467
Country	:	US
Telephone Number	:	787-870-8403
Fax Number	:	787-870-8403

Provider Business Practice Location Address
First Line	:	URB. SANFERNANDO CALLE 1
Second Line	:	A1
City	:	TOA ALTA
State	:	PR
Zip	:	00953
Country	:	US
Telephone Number	:	787-870-8403
Fax Number	:	787-870-8403

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	02/18/2009

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Directions to “ ELSIE MEDINA P.T.” Practice Location

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