Provider Demographics
NPI:1649834516
Name:AGRONT, MABEL R
Entity type:Individual
Prefix:
First Name:MABEL
Middle Name:R
Last Name:AGRONT
Suffix:
Gender:F
Credentials:
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 1570
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1570
Mailing Address - Country:US
Mailing Address - Phone:787-833-8700
Mailing Address - Fax:787-265-6155
Practice Address - Street 1:1040 AVENIDA LOS CORAZONES, CARR. #2 INT. BO. SABALO
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00681-0068
Practice Address - Country:US
Practice Address - Phone:787-833-8700
Practice Address - Fax:787-265-6155
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR716225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist