Provider Demographics
NPI:1912097387
Name:LUGO IRIZARRY, NELKY J (RPT)
Entity Type:Individual
Prefix:MS
First Name:NELKY
Middle Name:J
Last Name:LUGO IRIZARRY
Suffix:
Gender:F
Credentials:RPT
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 6515
Mailing Address - Street 2:SANTA ROSA UNIT
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-9005
Mailing Address - Country:US
Mailing Address - Phone:787-279-1496
Mailing Address - Fax:787-279-1496
Practice Address - Street 1:BELLA VISTA GARDENS COMMERICIAL CTR ROUTE 167
Practice Address - Street 2:SUITE 14-A
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-0000
Practice Address - Country:US
Practice Address - Phone:787-279-1496
Practice Address - Fax:787-279-1496
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0084193Medicare ID - Type Unspecified
PRS32029Medicare UPIN