Healthcare Provider Details

I. General information

NPI: 1316850399
Provider Name (Legal Business Name): PR PHYSICAL MEDICINE & REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MANUEL F. ROSSY ESQ. ISABEL II
BAYAMON PR
00960
US

IV. Provider business mailing address

PO BOX 117
TOA BAJA PR
00951-0117
US

V. Phone/Fax

Practice location:
  • Phone: 787-995-1900
  • Fax:
Mailing address:
  • Phone: 832-457-4312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIELLA HILLEBRAND
Title or Position: OWNER
Credential: MD
Phone: 832-457-4312