Provider Demographics
NPI:1154397941
Name:CORREA, ALICIA (RPT)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:CORREA
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:PO BOX 999
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-0999
Mailing Address - Country:US
Mailing Address - Phone:787-256-1358
Mailing Address - Fax:787-256-1358
Practice Address - Street 1:CARR 188 KM 1.5 PARCELAS NUEVAS
Practice Address - Street 2:BARRIO SAN ISIDRO
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-0000
Practice Address - Country:US
Practice Address - Phone:787-256-1358
Practice Address - Fax:787-256-1358
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR452225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0057979BMedicare UPIN
0084162Medicare UPIN
0058465AMedicare UPIN