Provider Demographics
NPI:1275780579
Name:CLINICA TERAPIA FISICA MANATI
Entity Type:Organization
Organization Name:CLINICA TERAPIA FISICA MANATI
Other - Org Name:DBA/CARMEN S. VAZQUEZ
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICAL THERAPIST/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:787-854-0165
Mailing Address - Street 1:HC 4 BOX 42414
Mailing Address - Street 2:BO: CUCHILLAS
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-854-0165
Mailing Address - Fax:787-854-0165
Practice Address - Street 1:CALLE 3 D-15 EDIFICIO OHARRIZ SUITE 2
Practice Address - Street 2:URBANIZACION FLAMBOYAN
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-854-0165
Practice Address - Fax:787-854-0165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0708261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR64375Medicare PIN