Provider Demographics
NPI:1558312306
Name:ROSA, MARIBELLA (PT)
Entity Type:Individual
Prefix:
First Name:MARIBELLA
Middle Name:
Last Name:ROSA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 12 BOX 7201
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-9242
Mailing Address - Country:US
Mailing Address - Phone:787-934-1406
Mailing Address - Fax:787-874-1449
Practice Address - Street 1:33 JUAN R GARZOT
Practice Address - Street 2:
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718
Practice Address - Country:US
Practice Address - Phone:787-874-0600
Practice Address - Fax:787-874-1449
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1249225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR50570Other1249
PR9580021Other1249
PR6606536501Other1249
PR9580021Other1249
PR50570Other1249