Provider Demographics
NPI:1154476893
Name:CLINICA DE TERAPIA FISICA NOGAL
Entity Type:Organization
Organization Name:CLINICA DE TERAPIA FISICA NOGAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:787-269-3725
Mailing Address - Street 1:URB DOS RIOS
Mailing Address - Street 2:E1 CALLE 9
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-269-3725
Mailing Address - Fax:787-786-4707
Practice Address - Street 1:URB ROYAL PALM
Practice Address - Street 2:IL25 AVE NOGAL
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-269-3725
Practice Address - Fax:787-786-4707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0084156Medicare ID - Type Unspecified