Provider Demographics
NPI:1497877211
Name:ROSADO ROJAS, LOURDES M (PT)
Entity Type:Individual
Prefix:MISS
First Name:LOURDES
Middle Name:M
Last Name:ROSADO ROJAS
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 COND LAGOS DEL NORTE APT 910
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-1605
Mailing Address - Country:US
Mailing Address - Phone:787-590-1781
Mailing Address - Fax:787-784-7909
Practice Address - Street 1:CONDOMINIO LAGOS DEL NORTE
Practice Address - Street 2:APT. 910
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-590-1781
Practice Address - Fax:787-784-7909
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1282225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR50143OtherPMC PROVIDER NUMBER
PR870084OtherMMM PROVIDER NUMBER
PR50143OtherPMC PROVIDER NUMBER
PRQ15482Medicare UPIN