Provider Demographics
NPI:1477588267
Name:BAEZMARTINEZ, HERIBERTO (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:HERIBERTO
Middle Name:
Last Name:BAEZMARTINEZ
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SANTA JUANITA INDIA ST.
Mailing Address - Street 2:AK-37
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-0000
Mailing Address - Country:US
Mailing Address - Phone:787-384-2944
Mailing Address - Fax:
Practice Address - Street 1:CHRISMAN ROAD
Practice Address - Street 2:
Practice Address - City:FORT BUCHANAN
Practice Address - State:PR
Practice Address - Zip Code:00934-0000
Practice Address - Country:US
Practice Address - Phone:787-707-2461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1028174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist