Provider Demographics
NPI:1497705388
Name:FISIO-MED
Entity Type:Organization
Organization Name:FISIO-MED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/TERAPISTA FISICO
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:LIZARDI
Authorized Official - Suffix:
Authorized Official - Credentials:RPT, DPT, ATRIC
Authorized Official - Phone:787-449-6462
Mailing Address - Street 1:135-9 CALLE 401
Mailing Address - Street 2:VILLA CAROLINA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-4006
Mailing Address - Country:US
Mailing Address - Phone:787-449-6462
Mailing Address - Fax:787-294-9862
Practice Address - Street 1:135-9 CALLE 401
Practice Address - Street 2:4TA EXT. VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-4006
Practice Address - Country:US
Practice Address - Phone:787-449-6462
Practice Address - Fax:787-294-9862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0057981Medicare PIN