Provider Demographics
NPI:1902085954
Name:CENTRO DE FISIOTERAPIA Y REHABILITACION
Entity Type:Organization
Organization Name:CENTRO DE FISIOTERAPIA Y REHABILITACION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TERAPISTA FISICO, OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:787-896-0459
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-0787
Mailing Address - Country:US
Mailing Address - Phone:787-896-0459
Mailing Address - Fax:787-896-0459
Practice Address - Street 1:AVE. EMERITO ESTRADA RIVERA # 1486
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-0787
Practice Address - Country:US
Practice Address - Phone:787-896-0459
Practice Address - Fax:787-896-0459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0087668Medicare PIN