Provider Demographics
NPI:1255528469
Name:CORDERO-FONTAINE, SAYAMIRA EULALIA (PT , DPT)
Entity type:Individual
Prefix:MRS
First Name:SAYAMIRA
Middle Name:EULALIA
Last Name:CORDERO-FONTAINE
Suffix:
Gender:F
Credentials:PT , DPT
Other - Prefix:MS
Other - First Name:SAYAMIRA
Other - Middle Name:EULALIA
Other - Last Name:CORDERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT , DPT
Mailing Address - Street 1:PO BOX 5706
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00823-5706
Mailing Address - Country:US
Mailing Address - Phone:340-713-7846
Mailing Address - Fax:
Practice Address - Street 1:201 202 EST. RUBY
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-778-6530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist