MEDICARE: PROFESSIONAL THERAPY GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	409	PR

General Provider Information

NPI Number	:	1164427068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL THERAPY GROUP INC

Provider Business Mailing Address
First Line	:	PO BOX 3240
Second Line	:
City	:	CAROLINA
State	:	PR
Zip	:	00984-3240
Country	:	US
Telephone Number	:	787-762-4940
Fax Number	:	787-257-1234

Provider Business Practice Location Address
First Line	:	ROBERTO CLEMENTE AVENUE
Second Line	:	117 BLOCK #1 VILLA CAROLINA
City	:	CAROLINA
State	:	PR
Zip	:	00985
Country	:	US
Telephone Number	:	787-762-4940
Fax Number	:	787-257-1234

Authorized Official
Title or Position	:	PHYSICAL THERAPY
Name	:	MRS. ALICIA CRUZ
Credential	:	PHYSICAL THERAPIST
Telephone Number	:	787-762-4940

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	04/14/2010

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