Healthcare Provider Details

I. General information

NPI: 1104039841
Provider Name (Legal Business Name): CENTRO TERAPIA FISICA REXVILLE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BC7 CALLE 33 REXVILLE
BAYAMON PR
00957-4144
US

IV. Provider business mailing address

RR 4 BOX 26936
TOA ALTA PR
00953-9414
US

V. Phone/Fax

Practice location:
  • Phone: 787-306-3229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number562
License Number StatePR

VIII. Authorized Official

Name: OLGA I JIMENEZ-MONT
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-306-3229