Provider Demographics
NPI:1902174683
Name:PULYTERAPIA SPA CORP
Entity Type:Organization
Organization Name:PULYTERAPIA SPA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOURINO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:786-970-2542
Mailing Address - Street 1:9369 FOUNTAINBLEAU BLVD APT J108
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5629
Mailing Address - Country:US
Mailing Address - Phone:786-970-2542
Mailing Address - Fax:786-275-4132
Practice Address - Street 1:9369 FOUNTAINBLEAU BLVD APT J108
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-5629
Practice Address - Country:US
Practice Address - Phone:786-970-2542
Practice Address - Fax:786-275-4132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA-65381261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)