Provider Demographics
NPI:1376524751
Name:VILLAFANE, ROSANA I (PT)
Entity Type:Individual
Prefix:MS
First Name:ROSANA
Middle Name:I
Last Name:VILLAFANE
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 1:1 CALLE VILLEGAS
Mailing Address - Street 2:PORTICOS DE GUAYNABO, APTO.17102
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971-9201
Mailing Address - Country:US
Mailing Address - Phone:787-274-8176
Mailing Address - Fax:787-274-8176
Practice Address - Street 1:950 CALLE 30 SE
Practice Address - Street 2:REPARTO METROPOLITANO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2323
Practice Address - Country:US
Practice Address - Phone:787-274-8176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1181225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRQ-23742Medicare UPIN
PR008-4934Medicare ID - Type Unspecified