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General NPI Number Information
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NPI Number | 1861764151
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Entity Type | Organization
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Legal Business Name | ES PHYSICAL THERAPY
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Dates
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Enumeration Date | 02/01/2012
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Last Update Date | 04/04/2014
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Provider Practice Location Address
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Address Line | 61 CALLE SAN PATRICIO
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City | LOIZA
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State | PR
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Zip | 00772-1750
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Country | US
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Telephone | 787-886-3398
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Fax | 787-886-3399
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Provider Business Mailing Address
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Address Line | PO BOX 1540
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City | FAJARDO
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State | PR
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Zip | 00738-1540
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Country | US
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Telephone | 787-413-9789
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Fax | 787-657-9624
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. EVELYN SANTOS
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Credential | RPT
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Telephone | 787-413-9789
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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 | 855
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License Number State | PR
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