Provider Demographics
NPI:1821405168
Name:SEDA DIAZ, ALEXIE HARRY (MSPT)
Entity Type:Individual
Prefix:
First Name:ALEXIE
Middle Name:HARRY
Last Name:SEDA DIAZ
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:K172 CALLE GUATEMALA
Mailing Address - Street 2:FOREST VIEW
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-2836
Mailing Address - Country:US
Mailing Address - Phone:787-459-8141
Mailing Address - Fax:
Practice Address - Street 1:#1 AVE. CASA LINDA SUITE 101,
Practice Address - Street 2:CARR. 177, KM 2.0 LOS FILTROS.
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-789-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist