Provider Demographics
NPI:1972588291
Name:HUERTAS GARCIA, PRISCILLA (RPT)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:HUERTAS GARCIA
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 1:5TH SEC. VILLA CAROLINA
Mailing Address - Street 2:ST.532 LOT 200 #30
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985
Mailing Address - Country:US
Mailing Address - Phone:787-752-2758
Mailing Address - Fax:787-752-2758
Practice Address - Street 1:5TH SEC. VILLA CAROLINA
Practice Address - Street 2:ST.532 LOT 200 #30
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-752-2758
Practice Address - Fax:787-752-2758
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0020495Medicare PIN