Provider Demographics
NPI:1083011563
Name:AQUANEURO THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:AQUANEURO THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSAYMA
Authorized Official - Middle Name:DELIRIS
Authorized Official - Last Name:LOPEZ RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:787-929-1594
Mailing Address - Street 1:PO BOX 33092
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00933-3092
Mailing Address - Country:US
Mailing Address - Phone:787-789-3481
Mailing Address - Fax:
Practice Address - Street 1:134 CALLE MORADILLA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5123
Practice Address - Country:US
Practice Address - Phone:787-789-3481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-26
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3252103T00000X
PR1242225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty