Healthcare Provider Details

I. General information

NPI: 1659749166
Provider Name (Legal Business Name): CENTRO INTEGRAL DE REHABILITACION Y TERAPIAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 4 BOX 9340
UTUADO PR
00641-7722
US

IV. Provider business mailing address

HC 4 BOX 9340
UTUADO PR
00641-7722
US

V. Phone/Fax

Practice location:
  • Phone: 939-274-0837
  • Fax:
Mailing address:
  • Phone: 787-391-8024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOSE JAVIER DIAZ VAZQUEZ
Title or Position: AUTHORIZED PERSON
Credential:
Phone: 939-274-0837