Provider Demographics
NPI:1861764151
Name:ES PHYSICAL THERAPY
Entity type:Organization
Organization Name:ES PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:787-413-9789
Mailing Address - Street 1:PO BOX 1540
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-1540
Mailing Address - Country:US
Mailing Address - Phone:787-413-9789
Mailing Address - Fax:787-657-9624
Practice Address - Street 1:61 CALLE SAN PATRICIO
Practice Address - Street 2:
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772-1750
Practice Address - Country:US
Practice Address - Phone:787-886-3398
Practice Address - Fax:787-886-3399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR855261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy