Healthcare Provider Details

I. General information

NPI: 1619996006
Provider Name (Legal Business Name): CENTRO DE TERAPIA FISICA EXPRESO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE PERIFERAL G 10 COOP CUIDAD UNIVERSITARIA
TRUJILLO ALTO PR
00976-2104
US

IV. Provider business mailing address

PO BOX 20897 PO BOX 20897
SAN JUAN PUERTO RICO
00928
UM

V. Phone/Fax

Practice location:
  • Phone: 787-760-8405
  • Fax:
Mailing address:
  • Phone: 787-760-8405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISSETTE ACOSTA RIVERA
Title or Position: PHYSICAL THERAPY
Credential:
Phone: 787-390-6659