Provider Demographics
NPI:1619996006
Name:CENTRO DE TERAPIA FISICA EXPRESO
Entity Type:Organization
Organization Name:CENTRO DE TERAPIA FISICA EXPRESO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPY
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:ACOSTA
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-390-6659
Mailing Address - Street 1:PO BOX 20897
Mailing Address - Street 2:PO BOX 20897
Mailing Address - City:SAN JUAN
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00928
Mailing Address - Country:UM
Mailing Address - Phone:787-760-8405
Mailing Address - Fax:
Practice Address - Street 1:AVE PERIFERAL G 10
Practice Address - Street 2:COOP CUIDAD UNIVERSITARIA
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-2104
Practice Address - Country:US
Practice Address - Phone:787-760-8405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0056786Medicare PIN