MEDICARE: CENTRO DE TERAPIA FISICA Y MEDICINA DEPORTIVA BELLA VISTA 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	225100000X	Physical Therapist	403	PR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	870057	OTHER	PR	MEDICARE Y MUCHO MAS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	5805	OTHER	PR	INTERNATIONAL MEDICAL CAR
3	20470	OTHER	PR	AMERICAN HEALTH
4	223015	OTHER	PR	PREFERRED HEALTH PLANS
5	9600108	OTHER	PR	HUMANA HEALTH PLANS

General Provider Information

NPI Number	:	1619067089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRO DE TERAPIA FISICA Y MEDICINA DEPORTIVA BELLA VISTA INC

Provider Business Mailing Address
First Line	:	PO BOX 6515
Second Line	:	SANTA ROSA UNIT
City	:	BAYAMON
State	:	PR
Zip	:	00960-5515
Country	:	US
Telephone Number	:	787-279-1496
Fax Number	:	787-279-1496

Provider Business Practice Location Address
First Line	:	ROUTE 167 CENTRO COM. BELLA VISTA GDNS
Second Line	:	SUITE 14-A
City	:	BAYAMON
State	:	PR
Zip	:	00957-6053
Country	:	US
Telephone Number	:	787-279-1496
Fax Number	:	787-279-1496

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MS. NELKY J. LUGO
Credential	:	R.P.T.
Telephone Number	:	787-279-1496

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	02/28/2013

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