Provider Demographics
NPI:1740655166
Name:CORIANO ANDALUZ, OLGA I (RPT)
Entity type:Individual
Prefix:MS
First Name:OLGA
Middle Name:I
Last Name:CORIANO ANDALUZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1144
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783-1144
Mailing Address - Country:US
Mailing Address - Phone:787-859-5755
Mailing Address - Fax:787-859-4307
Practice Address - Street 1:CARR 159 # KM13.5
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-2903
Practice Address - Country:US
Practice Address - Phone:787-859-5755
Practice Address - Fax:787-859-4307
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1042225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist