Basic Information
| Provider Information | |||||||||
| NPI: | 1871926758 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLINICA DE TERAPIA PROFESIONAL CSP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1917 | ||||||||
| Address2: | |||||||||
| City: | TRUJILLO ALTO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009771917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877608405 | ||||||||
| FaxNumber: | 7877608484 | ||||||||
| Practice Location | |||||||||
| Address1: | AVE. PERIFERAL G-10 | ||||||||
| Address2: | COOP. CUIDAD UNIVERSITARIA | ||||||||
| City: | TRUJILLO ALTO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009762133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877608405 | ||||||||
| FaxNumber: | 7877608484 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2013 | ||||||||
| LastUpdateDate: | 08/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | ACOSTA RIVERA | ||||||||
| AuthorizedOfficialFirstName: | LISSETTE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7877608405 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.