Provider Demographics
NPI:1528385457
Name:ROSARIO, LYDIA ESTHER (MSPT)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:ESTHER
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND SKY TOWER 1 APT 1J
Mailing Address - Street 2:CALLE HORTENSIA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6407
Mailing Address - Country:US
Mailing Address - Phone:787-674-4739
Mailing Address - Fax:
Practice Address - Street 1:COND SKY TOWER 1 APT 1J
Practice Address - Street 2:CALLE HORTENSIA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6407
Practice Address - Country:US
Practice Address - Phone:787-674-4739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist