Provider Demographics
NPI:1619257714
Name:PROFESSIONAL PHYSICAL THERAPISTS EXPRESS CORP
Entity Type:Organization
Organization Name:PROFESSIONAL PHYSICAL THERAPISTS EXPRESS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:787-475-5662
Mailing Address - Street 1:AVE PRINCIPAL
Mailing Address - Street 2:32 BAY VIEW
Mailing Address - City:CATANO
Mailing Address - State:PR
Mailing Address - Zip Code:00962
Mailing Address - Country:US
Mailing Address - Phone:787-248-9994
Mailing Address - Fax:
Practice Address - Street 1:STREET PRINCIPAL
Practice Address - Street 2:32 BAY VIEW
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962
Practice Address - Country:US
Practice Address - Phone:787-248-9994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00418225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0058393Medicare PIN