Provider Demographics
NPI:1972796464
Name:VAZQUEZ, MIRIAM D (PT)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:D
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ESTANCIAS DEL BLVD
Mailing Address - Street 2:BOX 128
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9570
Mailing Address - Country:US
Mailing Address - Phone:787-602-5119
Mailing Address - Fax:
Practice Address - Street 1:CASIA ST 10
Practice Address - Street 2:VHA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-5000
Practice Address - Country:US
Practice Address - Phone:787-641-7582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1009225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist