Provider Demographics
NPI:1477672186
Name:REYES-DIAZ, MAGDIE (PT)
Entity Type:Individual
Prefix:
First Name:MAGDIE
Middle Name:
Last Name:REYES-DIAZ
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 1:669 CALLE ESCORPION
Mailing Address - Street 2:VENUS GARDENS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4809
Mailing Address - Country:US
Mailing Address - Phone:787-458-6864
Mailing Address - Fax:
Practice Address - Street 1:669 CALLE ESCORPION
Practice Address - Street 2:VENUS GARDENS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4809
Practice Address - Country:US
Practice Address - Phone:787-458-6864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0010712251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics