Provider Demographics
NPI:1184633042
Name:VAZQUEZ RIVERA, CARMEN S (RPT)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:S
Last Name:VAZQUEZ RIVERA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MRS
Other - First Name:CARRMEN
Other - Middle Name:S
Other - Last Name:VAZQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:HC - 4 BOX 42414
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687-7025
Mailing Address - Country:US
Mailing Address - Phone:787-854-0165
Mailing Address - Fax:787-854-0165
Practice Address - Street 1:STREET 3 D-15 FLAMBOYAN URB.
Practice Address - Street 2:OHARRIZ BLDG SUITE 2
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-0000
Practice Address - Country:US
Practice Address - Phone:787-854-0165
Practice Address - Fax:787-854-0165
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00708225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0064375Medicare ID - Type UnspecifiedPROVIDER NUMBER