Provider Demographics
NPI:1578604070
Name:COLONDRES SANCHEZ, MAGDA GLORIE (RPT)
Entity Type:Individual
Prefix:
First Name:MAGDA
Middle Name:GLORIE
Last Name:COLONDRES SANCHEZ
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:PO BOX 641
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-0000
Mailing Address - Country:US
Mailing Address - Phone:787-647-6148
Mailing Address - Fax:833-901-2937
Practice Address - Street 1:431 SOUTHERN PECAN CIR UNIT 201
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-6328
Practice Address - Country:US
Practice Address - Phone:787-647-6148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1113225100000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84741Medicare ID - Type Unspecified
P84382Medicare UPIN