Provider Demographics
NPI:1003198755
Name:FUENTES RIVERA, LOURDES M (PT)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:M
Last Name:FUENTES RIVERA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LOURDES
Other - Middle Name:M
Other - Last Name:FUENTES RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:URB. JARDINES DE CAPARRA
Mailing Address - Street 2:CALLE 13 F18
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-0000
Mailing Address - Country:US
Mailing Address - Phone:787-397-6253
Mailing Address - Fax:787-785-5041
Practice Address - Street 1:URB. JARDINES DE CAPARRA
Practice Address - Street 2:CALLE 13 F18
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-0000
Practice Address - Country:US
Practice Address - Phone:787-397-6253
Practice Address - Fax:787-785-5041
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000724225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist