Provider Demographics
NPI:1497890537
Name:MORENO CRESPO, CARMEN I (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MISS
First Name:CARMEN
Middle Name:I
Last Name:MORENO CRESPO
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1066
Mailing Address - Street 2:EDIF. LAS VEGAS #420, BO CAMPO ALEGRE
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1066
Mailing Address - Country:US
Mailing Address - Phone:787-854-1426
Mailing Address - Fax:787-884-3757
Practice Address - Street 1:EDIF. LAS VEGAS #420, BO CAMPO ALEGRE
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-1086
Practice Address - Country:US
Practice Address - Phone:787-854-1426
Practice Address - Fax:787-884-3757
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR1240225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist