Provider Demographics
NPI:1508040189
Name:CENTRO DE REHABILITACION LA MONTANA
Entity Type:Organization
Organization Name:CENTRO DE REHABILITACION LA MONTANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:ADORNO
Authorized Official - Suffix:
Authorized Official - Credentials:MSS,PT
Authorized Official - Phone:787-884-8923
Mailing Address - Street 1:PO BOX 2173
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-2173
Mailing Address - Country:US
Mailing Address - Phone:787-884-8923
Mailing Address - Fax:787-854-4476
Practice Address - Street 1:J20 CALLE ELLIOT VELEZ
Practice Address - Street 2:URB. ATENAS
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4616
Practice Address - Country:US
Practice Address - Phone:787-884-8923
Practice Address - Fax:787-854-4476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR989261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRP31494Medicare UPIN