Provider Demographics
NPI:1114932944
Name:GRUPO FISIATRICO DE BAYAMON PTR
Entity Type:Organization
Organization Name:GRUPO FISIATRICO DE BAYAMON PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNWER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:MICHEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-740-2270
Mailing Address - Street 1:66 CALLE SANTA CRUZ
Mailing Address - Street 2:INSTITUTO SAN PABLO SUITE 301
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7041
Mailing Address - Country:US
Mailing Address - Phone:787-740-2270
Mailing Address - Fax:787-785-7277
Practice Address - Street 1:66 CALLE SANTA CRUZ
Practice Address - Street 2:INSTITUTO SAN PABLO SUITE 301
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7041
Practice Address - Country:US
Practice Address - Phone:787-740-2270
Practice Address - Fax:787-785-7277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0083953Medicare Oscar/Certification