Provider Demographics
NPI:1558985044
Name:CENTRO DE TERAPIA FISICA DE SAN SEBASTIAN
Entity Type:Organization
Organization Name:CENTRO DE TERAPIA FISICA DE SAN SEBASTIAN
Other - Org Name:YEZENIA VARGAS ROLDAN PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YEZENIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT REGISTER
Authorized Official - Phone:787-896-4080
Mailing Address - Street 1:PO BOX 3317
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-3317
Mailing Address - Country:US
Mailing Address - Phone:787-896-4080
Mailing Address - Fax:787-896-0042
Practice Address - Street 1:109 CALLE PAVIA FERNANDEZ
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-2206
Practice Address - Country:US
Practice Address - Phone:787-896-4080
Practice Address - Fax:787-896-0042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-01
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy