Provider Demographics
NPI:1932162955
Name:REYES GONZALEZ, NELLY (RPT)
Entity type:Individual
Prefix:
First Name:NELLY
Middle Name:
Last Name:REYES GONZALEZ
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 363001
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-3001
Mailing Address - Country:US
Mailing Address - Phone:787-638-4151
Mailing Address - Fax:787-746-8551
Practice Address - Street 1:AB5 CALLE NEBRASKA
Practice Address - Street 2:URB. CAGUAS NORTE
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2240
Practice Address - Country:US
Practice Address - Phone:787-704-0421
Practice Address - Fax:787-746-8551
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR624225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR50483OtherPMC MEDICARE CHOICE
PR825693OtherMEDICARE MUCHO MAS
PRS28106Medicare UPIN
PR50483OtherPMC MEDICARE CHOICE