Provider Demographics
NPI:1578951570
Name:RAMOS FRESSE, EVELYN (P T)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:RAMOS FRESSE
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BRASIL ST
Mailing Address - Street 2:GARDENVILLE
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2037
Mailing Address - Country:US
Mailing Address - Phone:787-782-2436
Mailing Address - Fax:787-782-2430
Practice Address - Street 1:50 CALLE BRAZIL
Practice Address - Street 2:GARDENVILLE
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-2033
Practice Address - Country:US
Practice Address - Phone:787-782-2436
Practice Address - Fax:787-782-2430
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1335225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4067762OtherDRIVERS LICENSE