Provider Demographics
NPI:1134155997
Name:ROSADO PENA, SANDRA (PT, MPT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:ROSADO PENA
Suffix:
Gender:F
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VILLAS DE PARQUE ESCORIAL
Mailing Address - Street 2:APT. 706
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-4828
Mailing Address - Country:US
Mailing Address - Phone:787-649-8007
Mailing Address - Fax:787-957-2478
Practice Address - Street 1:27-16 AVE ROBERTO CLEMENTE
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5420
Practice Address - Country:US
Practice Address - Phone:787-276-8123
Practice Address - Fax:787-957-2478
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00948225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0056660Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER