Healthcare Provider Details

I. General information

NPI: 1447226238
Provider Name (Legal Business Name): CENTRO DE MEDICINA FISICA Y REHABILITACION RIO GRANDE,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B18 CALLE GARCIA DE LA NOCEDA VILLAS DE RIO GRANDE
RIO GRANDE PR
00745-0000
US

IV. Provider business mailing address

PO BOX 2884
RIO GRANDE PR
00745-2884
US

V. Phone/Fax

Practice location:
  • Phone: 787-887-2555
  • Fax: 787-657-5600
Mailing address:
  • Phone: 787-887-2555
  • Fax: 787-657-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ISAMARIS ORTIZ FUENTES
Title or Position: PRESIDENT
Credential:
Phone: 787-887-2555