Provider Demographics
NPI:1831823228
Name:REYES MEDINA, GLORIMAR (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:GLORIMAR
Middle Name:
Last Name:REYES MEDINA
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:I18 CALLE PRINCIPAL
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-3772
Mailing Address - Country:US
Mailing Address - Phone:787-238-4146
Mailing Address - Fax:
Practice Address - Street 1:I-18 AVE. PRINCIPAL BARALT
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR732225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist