Healthcare Provider Details

I. General information

NPI: 1649159484
Provider Name (Legal Business Name): EDUC-KM THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 CALLE BALDORIOTY DE CASTRO STE 202
SAN JUAN PR
00918-4443
US

IV. Provider business mailing address

711 CALLE BALDORIOTY DE CASTRO STE 202
SAN JUAN PR
00918-4443
US

V. Phone/Fax

Practice location:
  • Phone: 787-632-4811
  • Fax:
Mailing address:
  • Phone: 787-632-4811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KIRSY MARIANO
Title or Position: PRESIDENTA
Credential:
Phone: 787-632-4811