Provider Demographics
NPI:1639494438
Name:REYES, IVON L (RAPT)
Entity Type:Individual
Prefix:MRS
First Name:IVON
Middle Name:L
Last Name:REYES
Suffix:
Gender:F
Credentials:RAPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PALMA REAL ST #14
Mailing Address - Street 2:CAMINO REAL
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00795
Mailing Address - Country:UM
Mailing Address - Phone:787-509-7333
Mailing Address - Fax:787-840-0490
Practice Address - Street 1:3301 CALLE CAOBA
Practice Address - Street 2:URB. LOS CAOBOS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-509-7333
Practice Address - Fax:787-840-0490
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000602261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy