Provider Demographics
NPI:1538649363
Name:VARGAS RAMOS, MARISOL (PTA)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:VARGAS RAMOS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 11663
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-6473
Mailing Address - Country:US
Mailing Address - Phone:787-908-0908
Mailing Address - Fax:
Practice Address - Street 1:4160 AVE ARCADIO ESTRADA STE 209
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-3211
Practice Address - Country:US
Practice Address - Phone:787-908-0908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000775225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant