Provider Demographics
NPI:1619960358
Name:REYES-RIVERA, WANDY (RPT)
Entity Type:Individual
Prefix:
First Name:WANDY
Middle Name:
Last Name:REYES-RIVERA
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 760
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-0760
Mailing Address - Country:US
Mailing Address - Phone:787-876-0250
Mailing Address - Fax:787-876-5618
Practice Address - Street 1:972 CALLE BAUHINIA
Practice Address - Street 2:LOIZA VALLEY
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-3410
Practice Address - Country:US
Practice Address - Phone:787-876-0250
Practice Address - Fax:787-876-5618
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR625225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0084149Medicare ID - Type UnspecifiedPROVIDER NUMBER