Provider Demographics
NPI:1922194646
Name:MONTANEZ OCASIO, MAYDEL (PT)
Entity Type:Individual
Prefix:MS
First Name:MAYDEL
Middle Name:
Last Name:MONTANEZ OCASIO
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:CIUDAD JARDIN I
Mailing Address - Street 2:CALLE MANZANILLA 22
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-466-0646
Mailing Address - Fax:787-712-0979
Practice Address - Street 1:MARINA PLAZA
Practice Address - Street 2:22-23
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-466-0646
Practice Address - Fax:787-712-0979
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0058392Medicare ID - Type UnspecifiedPROVIDER NUMBER MEDICARE