Provider Demographics
NPI:1720081144
Name:HUMARAN, YARA (RPT)
Entity Type:Individual
Prefix:
First Name:YARA
Middle Name:
Last Name:HUMARAN
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:E-14 CALLE CAMBALACHE, BZN 718
Mailing Address - Street 2:URB. VILLA FORESTAL
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-608-6001
Mailing Address - Fax:787-884-6408
Practice Address - Street 1:CARR #2 KM 45, SECTOR CANTERA
Practice Address - Street 2:BARRIO COTTO
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-608-6001
Practice Address - Fax:787-884-6408
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1195174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0084331Medicare ID - Type UnspecifiedPHYSICAL THERAPIST