Provider Demographics
NPI:1508034935
Name:ORTA RODRIGUEZ, BRENDA LEE (RPT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:ORTA RODRIGUEZ
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 1:1056 CALLE FERROCARRIL
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00925-3028
Mailing Address - Country:US
Mailing Address - Phone:787-217-5523
Mailing Address - Fax:787-287-9029
Practice Address - Street 1:1056 CALLE FERROCARRIL
Practice Address - Street 2:
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00925-3028
Practice Address - Country:US
Practice Address - Phone:787-764-8937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11322251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics