Healthcare Provider Details

I. General information

NPI: 1649524927
Provider Name (Legal Business Name): CENTRO JICMENET DE TERAPIA FISICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE LUIS M ALFARO
OROCOVIS PR
00720-4410
US

IV. Provider business mailing address

PO BOX 250
OROCOVIS PR
00720-0250
US

V. Phone/Fax

Practice location:
  • Phone: 787-867-6200
  • Fax: 787-867-6200
Mailing address:
  • Phone: 787-867-6200
  • Fax: 787-867-6200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number885
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. TERESITA SANTIAGO
Title or Position: TERAPISTA FISICO
Credential: LIC.
Phone: 787-867-6200