Provider Demographics
NPI:1285823492
Name:PHYSICAL THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SERVICES, INC.
Other - Org Name:PUERTO RICO PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, CPOA, CFOM,CDME
Authorized Official - Phone:787-854-5055
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00674
Mailing Address - Country:UM
Mailing Address - Phone:787-854-5055
Mailing Address - Fax:
Practice Address - Street 1:30 CALLE PADIAL
Practice Address - Street 2:GATSBY PLAZA SUITE 206
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-0000
Practice Address - Country:US
Practice Address - Phone:787-781-1135
Practice Address - Fax:787-858-4017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC15272222Z00000X, 224P00000X
DECFOM0333332BC3200X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0841050003Medicare NSC