Healthcare Provider Details

I. General information

NPI: 1639141302
Provider Name (Legal Business Name): FISIOTERAPIA EN LA MONTANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. ELLIOT VELEZ J-20
MANATI PR
00674-1854
US

IV. Provider business mailing address

PO BOX 1854
MOROVIS PR
00687-1854
US

V. Phone/Fax

Practice location:
  • Phone: 787-884-8923
  • Fax: 787-884-8923
Mailing address:
  • Phone: 787-884-8923
  • Fax: 787-884-8923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1122
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. ANGEL A. ADORNO
Title or Position: CO-OWNER
Credential: MSS, PT
Phone: 787-884-8923