Healthcare Provider Details

I. General information

NPI: 1871926758
Provider Name (Legal Business Name): CLINICA DE TERAPIA PROFESIONAL CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. PERIFERAL G-10 COOP. CUIDAD UNIVERSITARIA
TRUJILLO ALTO PR
00976-2133
US

IV. Provider business mailing address

PO BOX 1917
TRUJILLO ALTO PR
00977-1917
US

V. Phone/Fax

Practice location:
  • Phone: 787-760-8405
  • Fax: 787-760-8484
Mailing address:
  • Phone: 787-760-8405
  • Fax: 787-760-8484

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: LISSETTE M ACOSTA RIVERA
Title or Position: OWNER
Credential:
Phone: 787-760-8405