Provider Demographics
NPI:1063842896
Name:GRUPO FISIATRICO PPTS
Entity Type:Organization
Organization Name:GRUPO FISIATRICO PPTS
Other - Org Name:CENTRO DE FISIOTERAPIA Y SALUD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:RPT, ATRIC
Authorized Official - Phone:787-632-1555
Mailing Address - Street 1:100 GRAND BOULEVARD PASEOS
Mailing Address - Street 2:SUITE 112-248
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5559
Mailing Address - Country:US
Mailing Address - Phone:787-283-1554
Mailing Address - Fax:787-283-1554
Practice Address - Street 1:C2 AVE ALEJANDRINO
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4704
Practice Address - Country:US
Practice Address - Phone:787-283-1554
Practice Address - Fax:787-283-1554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR929261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR87407Medicare PIN