Provider Demographics
NPI:1023050085
Name:IRIZARRY, JESUS MANUEL (MSPT)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:MANUEL
Last Name:IRIZARRY
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND ANDALUCIA
Mailing Address - Street 2:APT 5301
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-518-9791
Mailing Address - Fax:787-752-3292
Practice Address - Street 1:143-8 CALLE 401
Practice Address - Street 2:4TA EXT VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-4022
Practice Address - Country:US
Practice Address - Phone:787-518-9791
Practice Address - Fax:787-752-9791
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist