Provider Demographics
NPI:1063495398
Name:PETRILLI, LOURDES (RPT)
Entity Type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:
Last Name:PETRILLI
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:979 CALLE YABOA REAL
Mailing Address - Street 2:URB. COUNTRY CLUB
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-3350
Mailing Address - Country:US
Mailing Address - Phone:787-750-6725
Mailing Address - Fax:787-750-6725
Practice Address - Street 1:979 CALLE YABOA REAL
Practice Address - Street 2:URB. COUNTRY CLUB
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-3350
Practice Address - Country:US
Practice Address - Phone:787-750-6725
Practice Address - Fax:787-750-6725
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRQ01713Medicare UPIN