Healthcare Provider Details

I. General information

NPI: 1497268908
Provider Name (Legal Business Name): BODY ALIGN STRUCTURAL MASSAGE HEALTH FOR WELLNESS CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 110 KM 4.9 INT BO AGUACATE
AGUADILLA PR
00603
US

IV. Provider business mailing address

HC 7 BOX 39597
AGUADILLA PR
00603-9220
US

V. Phone/Fax

Practice location:
  • Phone: 787-238-7909
  • Fax: 787-238-7909
Mailing address:
  • Phone: 787-238-7909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number142
License Number StatePR

VIII. Authorized Official

Name: MR. EDDIE N FELICIANO
Title or Position: SECRETARY
Credential:
Phone: 787-238-7909