Healthcare Provider Details

I. General information

NPI: 1952349672
Provider Name (Legal Business Name): UNIVERSAL THERAPY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 AVE PONCE DE LEON
SAN JUAN PR
00909-1844
US

IV. Provider business mailing address

PO BOX 79691
CAROLINA PR
00984-9691
US

V. Phone/Fax

Practice location:
  • Phone: 787-723-8784
  • Fax: 787-723-8470
Mailing address:
  • Phone: 787-723-8784
  • Fax: 787-723-8470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number09
License Number StatePR

VIII. Authorized Official

Name: GONZALO LOPEZ
Title or Position: CEO
Credential:
Phone: 787-723-8784