Provider Demographics
NPI:1083727309
Name:CORDERO, ELIZABETH (RPT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:CORDERO
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:URB. DOS CEIBAS #14
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-2832
Mailing Address - Country:US
Mailing Address - Phone:787-232-5368
Mailing Address - Fax:787-895-3863
Practice Address - Street 1:CARR. 4485 KM. 3.2 BO. SAN JOSE
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-2832
Practice Address - Country:US
Practice Address - Phone:787-232-5368
Practice Address - Fax:787-895-3863
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1225225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR57730Medicare ID - Type UnspecifiedPROVIDER NUMBER
PRQ-66947Medicare UPIN