Healthcare Provider Details

I. General information

NPI: 1275186017
Provider Name (Legal Business Name): BRS PHYSIATRY & SPORTS MEDICINE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 AVE ANDALUCIA INSTITUTO DE MEDICINA DEPORTIVA Y MANEJO DEL DOLOR
SAN JUAN PR
00920
US

IV. Provider business mailing address

PO BOX 353
MANATI PR
00674-0353
US

V. Phone/Fax

Practice location:
  • Phone: 787-957-5553
  • Fax:
Mailing address:
  • Phone: 787-957-5553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BELMARIE RODRIGUEZ SANTIAGO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-957-5553