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General NPI Number Information
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NPI Number | 1336359751
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Entity Type | Organization
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Legal Business Name | CENTRO DE TERAPIA FISICA Y MEDICINA DEPORTIVA SAN SEBASTIAN
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | CALLE JOSE MENDEZ CARDONA #3
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City | SAN SEBASTIAN
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State | PR
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Zip | 00678
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Country | US
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Telephone | 787-896-2335
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Fax | 787-896-2335
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Provider Business Mailing Address
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Address Line | URB EL RETIRO CALLE 2 C-5
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City | QUEBRADILLAS
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State | PR
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Zip | 00678
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Country | US
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Telephone | 787-896-2335
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Fax | 787-896-2335
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Authorized Official
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Title or Position | PHYSICAL THERAPIST OWNER
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Name | MS. IDALYSA MORALES
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Credential | RPT
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Telephone | 787-896-2335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1168
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License Number State | PR
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