Provider Demographics
NPI:1487761946
Name:CEDRES, MABEL (PT)
Entity type:Individual
Prefix:
First Name:MABEL
Middle Name:
Last Name:CEDRES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MABEL
Other - Middle Name:
Other - Last Name:CEDRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:URB. EL CEREZAL 1614 LOIRA ST.
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3034
Mailing Address - Country:US
Mailing Address - Phone:787-767-6378
Mailing Address - Fax:787-767-6378
Practice Address - Street 1:URB. EL CEREZAL 1614 LOIRA ST.
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3034
Practice Address - Country:US
Practice Address - Phone:787-767-6378
Practice Address - Fax:787-767-6378
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5-8413Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER