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General NPI Number Information
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NPI Number | 1578821542
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Entity Type | Organization
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Legal Business Name | PROHEALTH THERAPY & SPORTS REHAB, PSC
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Dates
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Enumeration Date | 04/27/2012
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Last Update Date | 08/13/2012
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Provider Practice Location Address
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Address Line | BO GUAYABO CARR 115 KM 20.6
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City | AGUADA
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State | PR
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Zip | 00602-9305
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Country | US
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Telephone | 787-313-0829
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Fax |
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Provider Business Mailing Address
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Address Line | HC 03 BOX 29780
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City | AGUADA
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State | PR
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Zip | 00602-9305
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Country | US
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Telephone | 787-313-0829
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Fax | 787-200-8030
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MRS. JENIFFER MARI VAZQUEZ
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Credential |
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Telephone | 787-313-0829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 1374
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License Number State | PR
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