Provider Demographics
NPI:1205854858
Name:PROFESSIONAL THERAPY & HEALTH SERVICES PSC.
Entity Type:Organization
Organization Name:PROFESSIONAL THERAPY & HEALTH SERVICES PSC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:TS
Authorized Official - Phone:787-785-9282
Mailing Address - Street 1:P12 AVE MAGNOLIA
Mailing Address - Street 2:MAGNOLIA GARDENS
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-2608
Mailing Address - Country:US
Mailing Address - Phone:787-785-9282
Mailing Address - Fax:787-785-9290
Practice Address - Street 1:P12 AVE MAGNOLIA
Practice Address - Street 2:MAGNOLIA GARDENS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-2608
Practice Address - Country:US
Practice Address - Phone:787-785-9282
Practice Address - Fax:787-785-9290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0084968Medicare ID - Type Unspecified