Healthcare Provider Details

I. General information

NPI: 1811081235
Provider Name (Legal Business Name): THERAPY@HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CARR 2 # KM
BARCELONETA PR
00617-3338
US

IV. Provider business mailing address

P.O. BOX 1621
MANATI PR
00674-1621
US

V. Phone/Fax

Practice location:
  • Phone: 787-400-0123
  • Fax: 787-846-1414
Mailing address:
  • Phone: 787-400-0123
  • Fax: 787-846-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number999
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number0999
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOSE ERNESTO RODRIGUEZ DE JESUS
Title or Position: PT
Credential:
Phone: 787-400-0123