Provider Demographics
NPI:1659454460
Name:RIVERA VAZQUEZ, GLADYS (RPT)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:RIVERA VAZQUEZ
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:URB. PALMAS DEL SUR 173
Mailing Address - Street 2:P.O. BOX 1220
Mailing Address - City:MOROVIS,
Mailing Address - State:PR
Mailing Address - Zip Code:00687-1220
Mailing Address - Country:US
Mailing Address - Phone:787-862-0869
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 55.2 BARRIO PALENQUE
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-0430
Practice Address - Country:US
Practice Address - Phone:787-846-4121
Practice Address - Fax:787-846-5661
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00936171R00000X
PR0936225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No171R00000XOther Service ProvidersInterpreterGroup - Single Specialty