Provider Demographics
NPI:1093405763
Name:BLUE THERAPY CORP
Entity Type:Organization
Organization Name:BLUE THERAPY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:WALDEMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-672-7575
Mailing Address - Street 1:URBANIZACION ESTANCIAS DE LA FUENTE 145D CALLE NARDO
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-3618
Mailing Address - Country:US
Mailing Address - Phone:787-960-6431
Mailing Address - Fax:
Practice Address - Street 1:URBANIZACION RIO PLANTATION CALLE 2 OESTE #4
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-960-6431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty