Healthcare Provider Details

I. General information

NPI: 1194776633
Provider Name (Legal Business Name): MRN THERAPY HOLISTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 CHIRINO OFFICES PLAZA 8838 SUITE 201
SAN JUAN PR
00926
US

IV. Provider business mailing address

PO BOX 875
TOA BAJA PR
00951-0875
US

V. Phone/Fax

Practice location:
  • Phone: 787-999-5538
  • Fax: 787-999-5539
Mailing address:
  • Phone: 787-309-8374
  • Fax: 787-999-5539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1257
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number916
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7932
License Number StatePR

VIII. Authorized Official

Name: NELSON COLON
Title or Position: PHYSICAL THERAPY
Credential:
Phone: 787-309-8374