Healthcare Provider Details

I. General information

NPI: 1275780579
Provider Name (Legal Business Name): CLINICA TERAPIA FISICA MANATI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 3 D-15 EDIFICIO OHARRIZ SUITE 2 URBANIZACION FLAMBOYAN
MANATI PR
00674
US

IV. Provider business mailing address

HC 4 BOX 42414 BO: CUCHILLAS
MOROVIS PR
00674
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-0165
  • Fax: 787-854-0165
Mailing address:
  • Phone: 787-854-0165
  • Fax: 787-854-0165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number0708
License Number StatePR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MRS. CARMEN S VAZQUEZ
Title or Position: PHYSICAL THERAPIST/ADMINISTRATOR
Credential: RPT
Phone: 787-854-0165