Healthcare Provider Details

I. General information

NPI: 1992987127
Provider Name (Legal Business Name): CENTRO DE TERAPIA FISICA TLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S11 CALLE CASTIGLIONI BAYAMON GARDENS
BAYAMON PR
00957-2430
US

IV. Provider business mailing address

CALLE 6 BLOQUE 6 #15 SECCION 3 DORAVILLE
DORADO PR
00946-5939
US

V. Phone/Fax

Practice location:
  • Phone: 787-317-9342
  • Fax:
Mailing address:
  • Phone: 787-317-9342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number887
License Number StatePR

VIII. Authorized Official

Name: MRS. IVONNE VILLANUEVA
Title or Position: PHYSICAL THERAPIST
Credential: R.P.T.
Phone: 787-317-9342