Healthcare Provider Details

I. General information

NPI: 1023076288
Provider Name (Legal Business Name): CENTRO DE TERAPIA FISICA Y CLINICA DEL DOLOR, CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 AVENIDA JF KENNEDY URBANIZACION FERNANDEZ
CIDRA PR
00739
US

IV. Provider business mailing address

4 AVENIDA JF KENNEDY URBANIZACION FERNANDEZ
CIDRA PR
00739
US

V. Phone/Fax

Practice location:
  • Phone: 787-714-0510
  • Fax: 787-714-0185
Mailing address:
  • Phone: 787-714-0510
  • Fax: 787-714-0185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ESPERANZA ORELLANA
Title or Position: VICE PRESIDENTA ADMINISTRADORA
Credential: RPTA
Phone: 787-714-0510