Provider Demographics
NPI:1720201775
Name:RODRIGUEZ RUIZ, GISELA (RPT)
Entity Type:Individual
Prefix:
First Name:GISELA
Middle Name:
Last Name:RODRIGUEZ RUIZ
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 5093
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-5093
Mailing Address - Country:US
Mailing Address - Phone:787-517-0871
Mailing Address - Fax:787-872-3232
Practice Address - Street 1:3623 AVE MILITAR
Practice Address - Street 2:SUITE 102 ISABELA PROFESSIONAL BUILDING
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-5800
Practice Address - Country:US
Practice Address - Phone:787-517-0871
Practice Address - Fax:787-872-3232
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRBT 554OtherMEDICARE