Healthcare Provider Details

I. General information

NPI: 1114932944
Provider Name (Legal Business Name): GRUPO FISIATRICO DE BAYAMON PTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 CALLE SANTA CRUZ INSTITUTO SAN PABLO SUITE 301
BAYAMON PR
00961-7041
US

IV. Provider business mailing address

66 CALLE SANTA CRUZ INSTITUTO SAN PABLO SUITE 301
BAYAMON PR
00961-7041
US

V. Phone/Fax

Practice location:
  • Phone: 787-740-2270
  • Fax: 787-785-7277
Mailing address:
  • Phone: 787-740-2270
  • Fax: 787-785-7277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM F MICHEO
Title or Position: CO-OWNWER
Credential: M.D.
Phone: 787-740-2270