Provider Demographics
NPI:1336703263
Name:PADILLA, MARIANELA (MPT, PT)
Entity Type:Individual
Prefix:MRS
First Name:MARIANELA
Middle Name:
Last Name:PADILLA
Suffix:
Gender:F
Credentials:MPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 CALLE LORCA URB VALLE ANDALUCIA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728
Mailing Address - Country:US
Mailing Address - Phone:787-975-5869
Mailing Address - Fax:
Practice Address - Street 1:21 AVE SANTIAGO DE LOS CABALLEROS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00733-0949
Practice Address - Country:US
Practice Address - Phone:787-848-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1069225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist