Provider Demographics
NPI:1457466872
Name:INSTITUTO TERAPEUTICO PONCE
Entity Type:Organization
Organization Name:INSTITUTO TERAPEUTICO PONCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-848-4445
Mailing Address - Street 1:PO BOX 336930
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-6930
Mailing Address - Country:US
Mailing Address - Phone:786-543-2948
Mailing Address - Fax:787-284-5380
Practice Address - Street 1:AVENUE EMILO FAGOT
Practice Address - Street 2:# 278
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00733-6930
Practice Address - Country:US
Practice Address - Phone:786-543-2948
Practice Address - Fax:787-284-5380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR85104Medicare ID - Type UnspecifiedMULTI SPECIALTY