Provider Demographics
NPI:1508061037
Name:ZAYAS-CRESPO, XANDRA N (RPT)
Entity Type:Individual
Prefix:
First Name:XANDRA
Middle Name:N
Last Name:ZAYAS-CRESPO
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:URB. GRAN VISTA 1 CAMINO DEL PLATA
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-8530
Mailing Address - Country:US
Mailing Address - Phone:939-630-2569
Mailing Address - Fax:787-870-6706
Practice Address - Street 1:URB. GRAN VISTA 1 CAMINO DEL PLATA
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-8530
Practice Address - Country:US
Practice Address - Phone:939-630-2569
Practice Address - Fax:787-870-6706
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
PR1375225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038279000Medicaid