Provider Demographics
NPI:1972804425
Name:RAMIREZ SOTO, JACKELYNE (PT)
Entity Type:Individual
Prefix:
First Name:JACKELYNE
Middle Name:
Last Name:RAMIREZ SOTO
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 1:127 CALLE D
Mailing Address - Street 2:BASE RAMEY
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-6311
Mailing Address - Country:US
Mailing Address - Phone:787-517-2993
Mailing Address - Fax:787-868-7439
Practice Address - Street 1:127 CALLE D
Practice Address - Street 2:BASE RAMEY
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-6311
Practice Address - Country:US
Practice Address - Phone:787-517-2993
Practice Address - Fax:787-868-7439
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1402225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist