Provider Demographics
NPI:1962090118
Name:MAISONET, SANDRA
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:MAISONET
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:PORTALES DE PARQUE ESCORIAL 32 BLVD MEDIA LUNA
Mailing Address - Street 2:APT I-9201
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-607-3943
Mailing Address - Fax:
Practice Address - Street 1:PORTALES DE PARQUE ESCORIAL 32 BLVD MEDIA LUNA
Practice Address - Street 2:APT I-9201
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-607-3943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR609225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist