Provider Demographics
NPI:1144623893
Name:CENTRO TERAPIAS ALIVIO
Entity type:Organization
Organization Name:CENTRO TERAPIAS ALIVIO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSANA
Authorized Official - Middle Name:I
Authorized Official - Last Name:VILLAFANE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:787-274-8176
Mailing Address - Street 1:HC 5 BOX 72261
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971-9656
Mailing Address - Country:US
Mailing Address - Phone:787-274-8176
Mailing Address - Fax:787-274-8176
Practice Address - Street 1:1255 AVE AMERICO MIRANDA
Practice Address - Street 2:URB. REPARTO METROPOLITANO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-1619
Practice Address - Country:US
Practice Address - Phone:787-274-8176
Practice Address - Fax:787-274-8176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRQ25742Medicare UPIN