Provider Demographics
NPI:1972689529
Name:SOTO TOLEDO, IVETTE (PT)
Entity Type:Individual
Prefix:MRS
First Name:IVETTE
Middle Name:
Last Name:SOTO TOLEDO
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:PO BOX 819
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-0819
Mailing Address - Country:US
Mailing Address - Phone:787-897-6611
Mailing Address - Fax:787-897-6611
Practice Address - Street 1:CARR 129 L, 21 HM 9 BO CALLEJONES LARES
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-0819
Practice Address - Country:US
Practice Address - Phone:787-897-6611
Practice Address - Fax:787-897-6611
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
50053OtherPREFERED MEDICARE CHOICE
56765 SOOtherMEDICARE OPTIMO
56765 SOOtherMEDICARE SELECTO
3304272OtherACAA
4562405OtherFAMILY CARE
PR660651790Medicaid
P804OtherFIRST MEDICAL
6690048OtherHUMANA
56765OtherTRIPLE C
870056OtherMEDICARE MUCHO MAS
6690048OtherHUMANA
56765 SOOtherMEDICARE SELECTO