Provider Demographics
NPI:1912147331
Name:MATIAS, CARMEN J
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:J
Last Name:MATIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. LLANOS DE GURABO
Mailing Address - Street 2:606CALLE ALELI
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-3720
Mailing Address - Country:US
Mailing Address - Phone:787-390-1734
Mailing Address - Fax:
Practice Address - Street 1:606 CALLE ALELI
Practice Address - Street 2:URB. LLANOS DE GURABO
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-3720
Practice Address - Country:US
Practice Address - Phone:787-390-1734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist