Provider Demographics
NPI:1861736894
Name:MALDONADO EMANUELLI, JENNIFER SOLEIL (PTA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SOLEIL
Last Name:MALDONADO EMANUELLI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CALLE KENNEDY
Mailing Address - Street 2:URB FERNANDEZ
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-3455
Mailing Address - Country:US
Mailing Address - Phone:787-714-0510
Mailing Address - Fax:
Practice Address - Street 1:4 CALLE KENNEDY
Practice Address - Street 2:URB FERNANDEZ
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-3455
Practice Address - Country:US
Practice Address - Phone:787-714-0510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2035225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant