Provider Demographics
NPI:1245578905
Name:ADVANCED PHYSIOTHERAPY CENTER COPR
Entity Type:Organization
Organization Name:ADVANCED PHYSIOTHERAPY CENTER COPR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:IVELLISE
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:787-926-1790
Mailing Address - Street 1:PO BOX 2839
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-2839
Mailing Address - Country:US
Mailing Address - Phone:787-926-1790
Mailing Address - Fax:787-926-1790
Practice Address - Street 1:526 AVE EMERITO ESTRADA
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-3119
Practice Address - Country:US
Practice Address - Phone:787-926-1790
Practice Address - Fax:787-926-1790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1365261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy