Healthcare Provider Details

I. General information

NPI: 1952791659
Provider Name (Legal Business Name): JOSE GUILLERMO AMY PM&R LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2015
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E22 CALLE SANTA CRUZ
BAYAMON PR
00961-6905
US

IV. Provider business mailing address

E22 CALLE SANTA CRUZ
BAYAMON PR
00961-6905
US

V. Phone/Fax

Practice location:
  • Phone: 787-798-3967
  • Fax: 787-269-5686
Mailing address:
  • Phone: 787-798-3967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number13118
License Number StatePR

VIII. Authorized Official

Name: DR. JOSE GUILLERMO AMY
Title or Position: PRESIDENT/MEDICAL DIRECTOR
Credential: M.D.
Phone: 787-798-3967