Provider Demographics
NPI:1558818336
Name:PHYSICAL & SPORTS REHABILITATION CLINIC
Entity Type:Organization
Organization Name:PHYSICAL & SPORTS REHABILITATION CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:YARED
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-463-3832
Mailing Address - Street 1:PO BOX 2382
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-2382
Mailing Address - Country:US
Mailing Address - Phone:787-877-5694
Mailing Address - Fax:787-877-5694
Practice Address - Street 1:CARR 111 KM 8.0
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-9998
Practice Address - Country:US
Practice Address - Phone:787-877-5694
Practice Address - Fax:787-877-5694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18872261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy