Provider Demographics
NPI:1760774806
Name:SEDA, LOURDES E (PT)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:E
Last Name:SEDA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#326 BROMELIA ST.
Mailing Address - Street 2:MONTE ELENA
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-5617
Mailing Address - Country:US
Mailing Address - Phone:787-360-0118
Mailing Address - Fax:
Practice Address - Street 1:326 CALLE BROMELIA
Practice Address - Street 2:URB. MONTE ELENA
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-5616
Practice Address - Country:US
Practice Address - Phone:787-360-0118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1081225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist