Provider Demographics
NPI:1407439292
Name:THERAPY LAB REHAB SERVICES, PSC
Entity Type:Organization
Organization Name:THERAPY LAB REHAB SERVICES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWN
Authorized Official - Prefix:
Authorized Official - First Name:YAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MSSLP
Authorized Official - Phone:787-505-3794
Mailing Address - Street 1:BORINQUEN VALLEY 2 NUM 382
Mailing Address - Street 2:CALLE CAPUCHINO
Mailing Address - City:CAGUA
Mailing Address - State:PR
Mailing Address - Zip Code:00725-9580
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:OCEANA HUB CENTER
Practice Address - Street 2:2 ACERINA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-513-8492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR822OtherLICENSE