Provider Demographics
NPI:1205936754
Name:OTERO RODRIGUEZ, SYLVIA ENID (RPT)
Entity type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:ENID
Last Name:OTERO RODRIGUEZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 558
Mailing Address - Street 2:
Mailing Address - City:GARROCHALES
Mailing Address - State:PR
Mailing Address - Zip Code:00652
Mailing Address - Country:US
Mailing Address - Phone:787-879-9406
Mailing Address - Fax:787-879-9406
Practice Address - Street 1:BO SANTANA CARR #2 KM 67.2
Practice Address - Street 2:PLAZA TAINA SUITE #2
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-879-9406
Practice Address - Fax:787-879-9406
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
50559OtherPMC
890514OtherMMM
S32047Medicare UPIN
88603Medicare ID - Type Unspecified