Provider Demographics
NPI:1477743714
Name:OMAR SOTO BARRETO
Entity Type:Organization
Organization Name:OMAR SOTO BARRETO
Other - Org Name:ALIVIUS THERTAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTO BARRETO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:787-882-6677
Mailing Address - Street 1:PO BOX 3161
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-3161
Mailing Address - Country:US
Mailing Address - Phone:787-882-6677
Mailing Address - Fax:
Practice Address - Street 1:PUNTO DE ORO BUILDING KM 124.7 #2 ST
Practice Address - Street 2:BO CAIMITAL BAJO
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-882-6677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty