Provider Demographics
NPI:1558543496
Name:RODRIGUEZ MIRANDA, ANA E (RPT)
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:E
Last Name:RODRIGUEZ MIRANDA
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 1:1136 AVENIDA MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-0643
Mailing Address - Country:US
Mailing Address - Phone:787-840-7780
Mailing Address - Fax:787-840-7780
Practice Address - Street 1:1136 AVENIDA MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0643
Practice Address - Country:US
Practice Address - Phone:787-840-7780
Practice Address - Fax:787-840-7780
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0498OtherRPT