Provider Demographics
NPI:1639587843
Name:DIAZ VAZQUEZ, JOSE JAVIER (MSPT)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:JAVIER
Last Name:DIAZ VAZQUEZ
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 9340
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-7722
Mailing Address - Country:US
Mailing Address - Phone:939-274-0837
Mailing Address - Fax:
Practice Address - Street 1:HC 4 BOX 9340
Practice Address - Street 2:
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-7722
Practice Address - Country:US
Practice Address - Phone:939-274-0837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4519225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist