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General NPI Number Information
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NPI Number | 1083011563
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Entity Type | Organization
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Legal Business Name | AQUANEURO THERAPY SERVICES, INC.
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Dates
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Enumeration Date | 11/26/2014
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Last Update Date | 07/19/2016
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Provider Practice Location Address
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Address Line | 134 CALLE MORADILLA
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City | SAN JUAN
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State | PR
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Zip | 00926-5123
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Country | US
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Telephone | 787-789-3481
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 33092
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City | SAN JUAN
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State | PR
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Zip | 00933-3092
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Country | US
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Telephone | 787-789-3481
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ROSAYMA DELIRIS LOPEZ RAMIREZ
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Credential | MA
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Telephone | 787-929-1594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3252
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1242
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License Number State | PR
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