Provider Demographics
NPI:1255410619
Name:SEVILLANO, SANDRA (RPT)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:SEVILLANO
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:PO BOX 367266
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-7266
Mailing Address - Country:US
Mailing Address - Phone:787-633-4744
Mailing Address - Fax:787-957-0222
Practice Address - Street 1:54 CALLE FLOR DEL RIO
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-3341
Practice Address - Country:US
Practice Address - Phone:787-633-4744
Practice Address - Fax:787-957-0222
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR933225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR870068OtherMEDICAREMUCHOMAS HEALTHCA
PR87124Medicare ID - Type Unspecified
PRS84874Medicare UPIN