Provider Demographics
NPI:1841632916
Name:REYES VALENCIA, IDALIA (PT)
Entity type:Individual
Prefix:
First Name:IDALIA
Middle Name:
Last Name:REYES VALENCIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE 44 NUM 702
Mailing Address - Street 2:URB FAIR VIEW
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-761-3938
Mailing Address - Fax:
Practice Address - Street 1:ROBERTO CLEMENTE HSING
Practice Address - Street 2:NUM 51 VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-7329
Practice Address - Country:US
Practice Address - Phone:787-768-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR000204OtherNUM LICENCIA TERAPISTA FISICO