Provider Demographics
NPI:1447291471
Name:DE JESUS TORRES, EVELYN (MPT)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:DE JESUS TORRES
Suffix:
Gender:F
Credentials:MPT
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 304
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-0304
Mailing Address - Country:US
Mailing Address - Phone:787-746-4610
Mailing Address - Fax:787-745-4030
Practice Address - Street 1:AVE. LUIS MUNOZ MARIN X-2
Practice Address - Street 2:URB. MARIOLGA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-6421
Practice Address - Country:US
Practice Address - Phone:787-746-4610
Practice Address - Fax:787-745-4030
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0571225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0571OtherPR LICENSE
S32021Medicare UPIN
0571OtherPR LICENSE