Provider Demographics
NPI:1215265202
Name:COLON-GAVILLAN, ADA I (PT,MPT)
Entity type:Individual
Prefix:
First Name:ADA
Middle Name:I
Last Name:COLON-GAVILLAN
Suffix:
Gender:F
Credentials:PT,MPT
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 9030
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-9030
Mailing Address - Country:US
Mailing Address - Phone:787-585-3610
Mailing Address - Fax:
Practice Address - Street 1:VILLA CAROLINA
Practice Address - Street 2:104-17 104STREET
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-752-0869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR776261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy