Healthcare Provider Details

I. General information

NPI: 1619541604
Provider Name (Legal Business Name): PUERTO RICO HAND AND SPORTS REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 AVE MANUEL DOMENECH STE 402
SAN JUAN PR
00918-3754
US

IV. Provider business mailing address

400 AVE MANUEL DOMENECH STE 402
SAN JUAN PR
00918-3754
US

V. Phone/Fax

Practice location:
  • Phone: 787-689-7803
  • Fax: 844-865-3827
Mailing address:
  • Phone: 787-689-7803
  • Fax: 844-865-3827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. CRISTIAN PRADO-CAPETILLO
Title or Position: OWNER
Credential: MD
Phone: 904-315-0394