Provider Demographics
NPI:1891209029
Name:HERNANDEZ-MANTILLA, ANABEL (PT)
Entity Type:Individual
Prefix:
First Name:ANABEL
Middle Name:
Last Name:HERNANDEZ-MANTILLA
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 1:76 RUTA 25
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-3944
Mailing Address - Country:US
Mailing Address - Phone:787-891-4833
Mailing Address - Fax:787-882-5405
Practice Address - Street 1:EDIF CENTERPLEX SUITE 103
Practice Address - Street 2:PR 2 KM 133.5
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-891-4833
Practice Address - Fax:787-882-5405
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4542225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4542OtherPHYSICAL THERAPIST BOARD