Provider Demographics
NPI:1619541604
Name:PUERTO RICO HAND AND SPORTS REHABILITATION LLC
Entity Type:Organization
Organization Name:PUERTO RICO HAND AND SPORTS REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRADO-CAPETILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-315-0394
Mailing Address - Street 1:400 AVE MANUEL DOMENECH STE 402
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3754
Mailing Address - Country:US
Mailing Address - Phone:787-689-7803
Mailing Address - Fax:844-865-3827
Practice Address - Street 1:400 AVE MANUEL DOMENECH STE 402
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3754
Practice Address - Country:US
Practice Address - Phone:787-689-7803
Practice Address - Fax:844-865-3827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHandGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1271344-0011OtherCERT REGISTRO DE COMERCIANTE
PR463736OtherCERTIFICADO DE ORGANIZACION