Healthcare Provider Details

I. General information

NPI: 1568893600
Provider Name (Legal Business Name): SIGFREDO ANTONIO ALICEA VALENTIN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2013
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ROOSEVELT AVENUE SUITE 407 CLINICA LAS AMERICAS
SAN JUAN PR
00918-1156
US

IV. Provider business mailing address

400 ROOSEVELT AVENUE SUITE 407 CLINICA LAS AMERICAS
SAN JUAN PR
00918-1156
US

V. Phone/Fax

Practice location:
  • Phone: 787-274-0527
  • Fax: 787-764-7963
Mailing address:
  • Phone: 787-274-0527
  • Fax: 787-764-7963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number852
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: