Healthcare Provider Details

I. General information

NPI: 1417147729
Provider Name (Legal Business Name): ACTIVO Y EN MOVIMIENTO TERAPIA FISICA Y OCUPACIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 CALLE GERANIO HACIENDA FLORIDA
YAUCO PR
00698-4536
US

IV. Provider business mailing address

CALLE GERANIO 491 HACIENDA FLORIDA
YAUCO PR
00698-4536
US

V. Phone/Fax

Practice location:
  • Phone: 787-849-3884
  • Fax: 787-849-3884
Mailing address:
  • Phone: 787-849-3884
  • Fax: 787-849-3884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number1068
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number1033
License Number StatePR

VIII. Authorized Official

Name: MRS. ALMA ORTIZ NIEVES
Title or Position: PRESIDENT
Credential: MPT,PT
Phone: 787-849-3884