Provider Demographics
NPI:1902168420
Name:FUNCTIONAL RESTORATION PSC
Entity Type:Organization
Organization Name:FUNCTIONAL RESTORATION PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PEREZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEJANDRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD,MPH,DABPMR
Authorized Official - Phone:787-782-2436
Mailing Address - Street 1:50 CALLE BRAZIL STE 3
Mailing Address - Street 2:GARDENVILLE
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2037
Mailing Address - Country:US
Mailing Address - Phone:787-782-2436
Mailing Address - Fax:787-782-2430
Practice Address - Street 1:E22 CALLE SANTA CRUZ
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6905
Practice Address - Country:US
Practice Address - Phone:787-782-2436
Practice Address - Fax:787-782-2430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty