Provider Demographics
NPI:1073275137
Name:REYES CARRASQUILLO, LUIS GERARDO
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:GERARDO
Last Name:REYES CARRASQUILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LUIS
Other - Middle Name:GERARDO
Other - Last Name:REYES CARRASQUILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:CALLE UNO APT 27B
Mailing Address - Street 2:CONDOMINO VISTAS DEL RIO
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-306-2684
Mailing Address - Fax:
Practice Address - Street 1:15 AVEMUNOZ RIVERA
Practice Address - Street 2:PASEO CARIBE BUILDING STE 104
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901
Practice Address - Country:US
Practice Address - Phone:888-900-0073
Practice Address - Fax:787-289-8715
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4593225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist