Provider Demographics
NPI:1417077504
Name:FELICIANO, YOLANDA (RPT)
Entity Type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:
Last Name:FELICIANO
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 FERNANDEZ AVE JFK 4
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739
Mailing Address - Country:US
Mailing Address - Phone:787-714-0510
Mailing Address - Fax:787-714-0185
Practice Address - Street 1:AVE JOHN F KENNEDY 4
Practice Address - Street 2:URB FERNANDEZ
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-0000
Practice Address - Country:US
Practice Address - Phone:787-714-0510
Practice Address - Fax:787-714-0185
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8-7119Medicare ID - Type Unspecified