Healthcare Provider Details

I. General information

NPI: 1871979815
Provider Name (Legal Business Name): CENTRO DE TERAPIA FISICA DE SANTA ROSA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10-2 AVE AGUAS BUENAS URB. SANTA ROSA
BAYAMON PR
00959-6611
US

IV. Provider business mailing address

PO BOX 383
BAYAMON PR
00960-0383
US

V. Phone/Fax

Practice location:
  • Phone: 787-780-5910
  • Fax:
Mailing address:
  • Phone: 787-780-5910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. CARMEN L AYBAR-OTERO
Title or Position: ADMINISTRATAOR
Credential:
Phone: 787-780-5910