Healthcare Provider Details

I. General information

NPI: 1891906434
Provider Name (Legal Business Name): CENTRO FISIATRICO COUNTRY CLUB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PB30 CALLE 266 EL COMANDANTE
CAROLINA PR
00982-2767
US

IV. Provider business mailing address

PB30 CALLE 266 EL COMANDANTE
CAROLINA PR
00982-2767
US

V. Phone/Fax

Practice location:
  • Phone: 787-276-3366
  • Fax:
Mailing address:
  • Phone:
  • 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: MAITE URQUIA ARAN
Title or Position: ADMINISTRADORA
Credential:
Phone: 787-276-3366