Provider Demographics
NPI:1245325497
Name:PHYSICAL THERAPY AND REHABILITATION CENTER
Entity type:Organization
Organization Name:PHYSICAL THERAPY AND REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/ ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRILLI
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:787-750-6725
Mailing Address - Street 1:979 CALLE YABOA REAL
Mailing Address - Street 2:URB. COUNTRY CLUB
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-3350
Mailing Address - Country:US
Mailing Address - Phone:787-750-6725
Mailing Address - Fax:787-750-6725
Practice Address - Street 1:979 CALLE YABOA REAL
Practice Address - Street 2:URB. COUNTRY CLUB
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-3350
Practice Address - Country:US
Practice Address - Phone:787-750-6725
Practice Address - Fax:787-750-6725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy