Provider Demographics
NPI:1578590618
Name:RONDON DE JESUS, RAUL (PT)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:RONDON DE JESUS
Suffix:
Gender:M
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:RR 6 BOX 9689
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9429
Mailing Address - Country:US
Mailing Address - Phone:787-604-4353
Mailing Address - Fax:787-720-4216
Practice Address - Street 1:CARR 842
Practice Address - Street 2:BARRIO CAIMITO BAJO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5972
Practice Address - Country:US
Practice Address - Phone:787-604-4353
Practice Address - Fax:787-720-4101
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1175225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist