Provider Demographics
NPI:1619067089
Name:CENTRO DE TERAPIA FISICA Y MEDICINA DEPORTIVA BELLA VISTA INC
Entity Type:Organization
Organization Name:CENTRO DE TERAPIA FISICA Y MEDICINA DEPORTIVA BELLA VISTA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:NELKY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:787-279-1496
Mailing Address - Street 1:PO BOX 6515
Mailing Address - Street 2:SANTA ROSA UNIT
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-5515
Mailing Address - Country:US
Mailing Address - Phone:787-279-1496
Mailing Address - Fax:787-279-1496
Practice Address - Street 1:ROUTE 167 CENTRO COM. BELLA VISTA GDNS
Practice Address - Street 2:SUITE 14-A
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-6053
Practice Address - Country:US
Practice Address - Phone:787-279-1496
Practice Address - Fax:787-279-1496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR870057OtherMEDICARE Y MUCHO MAS
PR5805OtherINTERNATIONAL MEDICAL CAR
PR20470OtherAMERICAN HEALTH
PR223015OtherPREFERRED HEALTH PLANS
PR9600108OtherHUMANA HEALTH PLANS
PR=========OtherPREFERRED MEDICARE CHOICE
PR9600108OtherHUMANA HEALTH PLANS
PR20470OtherAMERICAN HEALTH
PR5805OtherINTERNATIONAL MEDICAL CAR
PR870057OtherMEDICARE Y MUCHO MAS
PR=========OtherCIGNA HEALTH PLANS
PR=========OtherOPTION HEALTHCARE NETWORK