Healthcare Provider Details

I. General information

NPI: 1780656413
Provider Name (Legal Business Name): PHYSICAL THERAPY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ATENAS MEDICAL & SHOPPING CENTER URB. ATENAS SUITE 4 & 6
MANATI PR
00674-4616
US

IV. Provider business mailing address

PO BOX 56
MANATI PR
00674-0056
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-5055
  • Fax: 787-807-2299
Mailing address:
  • Phone: 787-854-5055
  • Fax: 787-807-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberC15272
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberC15272
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier55042
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerTRIPLE S
# 2
Identifier0841050001
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerMEDICARE NSC
# 3
Identifier1780656413
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerPROSAM

VIII. Authorized Official

Name: MRS. MELISSA MALDONADO
Title or Position: PRESIDENT
Credential: RPH, CPOA, CFOM,CDME
Phone: 787-854-5055