Provider Demographics
NPI:1104849942
Name:CORREA-RODRIGUEZ, EVELYN (PT)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:
Last Name:CORREA-RODRIGUEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EXTENSION ALTA VISTA CALLE 25 PP-6
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-4248
Mailing Address - Country:US
Mailing Address - Phone:787-812-3030
Mailing Address - Fax:787-651-4306
Practice Address - Street 1:EXTENSION ALTA VISTA PP-6 CALLE 25
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4248
Practice Address - Country:US
Practice Address - Phone:787-812-3030
Practice Address - Fax:787-651-4306
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist