Provider Demographics
NPI:1578761250
Name:ROSARIO, MARTIN GILBERTO (PT, DS)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:GILBERTO
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:PT, DS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR 689 B0 CEIBA CARMELITA
Mailing Address - Street 2:BUZON #1
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-414-6395
Mailing Address - Fax:
Practice Address - Street 1:CARR 689 B0 CEIBA CARMELITA
Practice Address - Street 2:BUZON #1
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-414-6395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1371174400000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No174400000XOther Service ProvidersSpecialist