Healthcare Provider Details

I. General information

NPI: 1467236943
Provider Name (Legal Business Name): HOLISTIC REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 08/24/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CALLE 5 BLOQUE C ESTANCIAS DE SAN FERNANDO
CAROLINA PR
00985
US

IV. Provider business mailing address

1299 W BOSH APT 906 TERRAZAS SAN JUAN
SAN JUAN PR
00924-4668
US

V. Phone/Fax

Practice location:
  • Phone: 787-637-4897
  • Fax:
Mailing address:
  • Phone: 787-637-4897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: LYNETTE RIOS RODRIGUEZ
Title or Position: SOLE MBR
Credential:
Phone: 787-637-4897