Provider Demographics
NPI:1376816769
Name:PHYSICAL THERAPY-ORTHO REHAB
Entity Type:Organization
Organization Name:PHYSICAL THERAPY-ORTHO REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCDA
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CASINAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-455-7824
Mailing Address - Street 1:HC 03 BOX 14390
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698
Mailing Address - Country:US
Mailing Address - Phone:787-455-7824
Mailing Address - Fax:
Practice Address - Street 1:ESCUELA DE MEDICINA
Practice Address - Street 2:1575 AVE. MUNOZ RIVERA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-455-7824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1109261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0080291Medicare PIN